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12/31/2008 12:22 70774F '1 PAGE 01/01 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD IAG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 EOSt Main Street, Stockton, CA 95202-3029 <br /> � I <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjg e <br /> PUBLIC RECORDS RELEASE APPLICATI <br /> .�..�\�•r lLf` <br /> i�=! F?P=LIt°rfAtJ'[:f �C BUSINESS/AGENCY: C2r�°J ��SOGi4`I-@✓ <br /> P i- <br /> .'A -rte <br /> ADDRESS: `t(� Ftit`S : 1.$T-6 �Z CltW&2tel2ip �3e'y1lG(Q C4 C( stcl <br /> PHONE(1): �� ��$ � PHONE(2): p `` 11__ FACSIMILE: 7017 7yS 6a?.V <br /> TENTATIVE*APPOINTMENT DATE., 1�l J_aQV Ct3L V Time: G A f�t.Pfj 1�51 I'e�6M <br /> (Please allow 9D business days from date of applicasubmltta "Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST- ( AS OR G REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE uzz,Los <br /> Electronic Information: ❑List❑Map�Descriptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name Clty . _ Unit 1 <br /> 1. 1000 E....pv "A.f Si CV_tT-b Ct <br /> 2. L ( q►T►te l ` C{�T /O F,F ❑ Unit 2 <br /> 3. <br /> 4. Unit 3 <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 Q L-L- to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACIL"/VEMICLE <br /> 19.10THER CLEANUP SITE(NON-LOP) ©FOOD FACILrrY 0 WASTE TIRE <br /> OR UNDERGROUND TANK(MONITORING/REMOVAL) M DOG KENNEL C1 DAIRY <br /> 14 HAZARDOUS WASTE GENERATOR Ci CHICKEN RANCH Cl WAsTEwATRA TREATMENT PLANT <br /> TIERED PERMITTED FACILITY M MOTEL/HOTEL CI PUMPER TRUCK/YARD/CHEM TOILETS <br /> 7ATTooiBODY PIERCING Q POOLlSPA C LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHE'A(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REmEw - MONDAY-FRIDAY 8:00 AM-5:00PM -EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Selebt the type(s)of flies from the list above by checking the appropriate <br /> box(es)- At least one file type MUST be selected. -F-ax-.to(209)464-0138 or mall 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 flies dxist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4$.08 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />