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DATE <br /> SAN JOAQUIN COUNTY Ei NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTME <br /> 411r, 1 7 2007 600 East Main St. Stockton, CA 95202-2708 <br /> ephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov. g/e <br /> EPdUlRUiui� E���HEk1i� <br /> PERtvlii/SERVICE 75?LM <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: VA 1A G 4 A WA. —V,E(!Z,' BUSINESS/AGENCY: <br /> ADDRESS: :R Q :S-41y (1A-tic I S ('Z> C14, 9e-+l a11iz— <br /> PHONE (1): 4t ��"��`�2 �(02o PHONE(2): W ° �l i 2 3 FACSIMILE: T(S__ ' S 2-2 32,7-.7 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE R�EJQT-$98.00�E(CASH OR CH CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �U DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. 131 ^ i C �123�/Cl d <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> ❑ unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> K JNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> yOTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> . UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHD 4"6 9/14/2006 <br />