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DAE� V IJ Ea - <br /> SAN,TOAQUIN COUNTY EHD LOG NUMBER <br /> "�/ ✓ 0 2007 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029q# <br /> ENMUNMENT HEALNIephone: (209)468-3420 Fax: (209)464-0138 Web: www.sj ov. eh <br /> PERM T,/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: L#4z;_ j j,L&taA Q I �` BU <br /> USSINESS/AGENCY: � s� 74I.C. / <br /> ADDRESS: p`f�9a r70vQ1GLS U ✓Q . �J � V TCt�IiRQ�/. Ll�} q1 /S/"�p� <br /> PHONE(1): /i(f —7 8?6,—Z��(D PHONE(2): 5p,,��-1I91059(a) FACSIMILE: /1l,' 7p�e�03 G 40 <br /> TENTATIVE*APPOINTMENT DATE: Ay6s ND U Z7 M-7 Time: 7 3)a✓✓ <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RE UEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /I/19/07 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 1. 00 '14 a a <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> Unit 4 \` <br /> 6. <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Reques ed: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILF�,S <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT LID WASTE FACILITY/VEHICLE r <br /> UN'PT CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE 'V <br /> DERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL DAIRY <br /> 11SHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> (/IJ TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 WEB 8/8/2007 <br />