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EHD LUG NUMBER <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY <br /> I11 EC 1J Lam© EN\'I�ONMENTAL HEALTH DEPART I N'r <br /> 600 East Maiit Street, Stockton, CA 95202-2708 <br /> NOV 2 6 2007 Tele 204 hone: 468-3420 Fax: (209) 464-0138 Web: N"vw.Sjgoov� (. ) <br /> ENV1ROWEN'T HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 7��.0 Er C BUSINESSIAGENCY: s <br /> ADDRESS: qrq_5 C+— <br /> PHONE(t):04-19`) -?— PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 14 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 173 CHECK BOX TO EXPEDITE QUEST.$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> -1146 <br /> r3. <br /> LlUnit 2 <br /> - — <br /> 4 Unit 3 <br /> P, <br /> 6• <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9• ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT R SOLID WASTE FACILITYNEHICLE <br /> _RCOTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> :UNDERGROUND TANK(MONITORINGIREMOVAL) CI DOG KENNEL I-] DAIRY <br /> AZARDOUS WASTE GENERATOR 13 CHICKEN RANCH CI WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY Q MOTELIHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> Q TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM - 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 fife 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 behold 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> **` If you should need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> ErlDaa.os s�larzaos <br />