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DATE SAN JOA UIN COUNTY EHD LOG NUMBER <br /> ENVIIt MENTAL HEALTH DEPARTME� <br /> 2007 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRONMENT HE�[.it� <br /> euhone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov. g/e <br /> PERfv!ii/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: IVa LA 410 BUSINESS/AGENCY: <br /> ADDRESS: y �o I c`� o "T41y (')-AA/C I C^ 9 q/ a p� <br /> PHONE(1): ��-� 1�- - �02o PHONE(2): Lr S:-" ZI �' F Z 3 FACSIMILE: T(r ` 512? <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 REQ' T-$98.00 E(CASH OR CH CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �G�G DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. <br /> /_31 <br /> c cS(23�/G(cam <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4 Unit 3 (�J <br /> 5. 90 <br /> 6. OK-Unit 4 <br /> 1t <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 /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT El SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) C1 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> 11 TATTOO/BODY PIERCING ❑POOL/SPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑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 48-06 9/14/2006 <br />