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SEP. 21. 2007 2: 12PM C(�� EARTH TECH NO. 4867 P. 1 <br /> DATE RECEIVED <br /> RIRC S f I VF=� <br /> DSAN JOAQUIN COUNTYlOG NUMBER <br /> uENVIRONMENTAL HEALTH DEPARTMENT <br /> 7 600 East Main Street, Stockton,CA 95202-3029 <br /> SEP LOD TelePhooe: (209)468-3420 Fax;(209)464-0138 web: www.sjgov.Org/ehd <br /> ENV!R01i1fO^Effl' PiIC-ALT$UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Gt SC7 j) C (�YJ Ct <br /> _ �/ �7 BUSINESSIAGENCY: O/cam/ PS <br /> ADDRESS: ���G� C1IrCT U! ✓/ <br /> PHONE(1): PHONE PHONE(2): FACSIMILE: �f'^ <br /> TENTATIVE*APPOINTMENT DATE:�/0e/r -1�� e Time: <br /> (please allow 10 business days from data of application submittal-*Tentative only.must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUES - 98.00 P7FE(CASH OR CH LY)-REQU T CESSED IN 3 BUS NESS D YS <br /> SIGNATURE OF APPLICANT DATE 9 <br /> Electronic Information: ❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 7 <br /> 2. � J`~ /� L/r or a v �o l 7 ✓ Unit 2 <br /> 3. I?00 C�cz P V- <br /> 4. <br /> _Too No `� Isoe o a C� Unit 3 <br /> 8. y'3Q L r P✓� �J 5'�d �0 r /�t ❑ units l <br /> 9. <br /> unit s <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESN. <br /> NOERGROUND TANK(UST)CLEANUP SITE(LOP) C2HOUSING ABATEMENT $OLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FooD FACILITY 13 WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) El DOG KENNEL 13 DAIRY <br /> AZARDOus WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT <br /> Q TIERED PERMITTED FACILITY 0 MOTEL/HO'rEL ❑PUMPERTRUCK/YARD/CHEM <br /> TATTOO/BODY PIERCING 0 POOLISPA �S LAND USE APPLICATION SITE5 <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE$PECIFY) / <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 9:00 AM-,5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Selei!t the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be <br /> sOf d. FAX to 209 464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additio assistan with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next i s day' <br /> 2. The EHD will notify the applicant _ H6-files exist. nt for review will be confirmed approximately ten(10) <br /> days after receipt of application:) s will be held fo i Ne business days for review. Appointments <br /> should be scheduled according) <br /> 3. A file that is actively being worse on by EHD staff may not be imme i le 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 EH taff at the expense of the applicant. <br /> Future fife reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EH048Ab WEB 6/8/2007 <br />