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10/22/2008 10:24 FAX 9258272392 001 <br /> 0 $ <br /> o �E6 EB-�-, -- EHD LOG NUMBER <br /> L� SAN JOAQUIN COUNTY <br /> L �I •i J ENVIRONMENTAL HEALTH DEPARTMENT /�///��� <br /> r, ��p 600 East Main Street, Stockton, CA 95202-3029 o vl / 1 <br /> ('(" ( � �T�lephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov:or hd/1 1! <br /> VVV <br /> EPvVir�,l)N�;'i__�;(('i�� �i�tiLTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ✓ala �i1�J( tr-'l� BUSINESS/AGENCY: l%A A -I`AE�—LL fn) <br /> ADDRESS: \� a0J y�L}.. 4T cAr%e) H vi Clty/statelzip �h-�7r1_10 C 520 <br /> PHONE(1):�-7(� )3��'�"l 1 PHONE(2):(-Ch"5) G� FACSIMILE�a25 2A%- O$$$ <br /> TENTATIVE*APPOINTMENT DATE: �� 6� o Time: 'c>iy o AM r <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) 2 <br /> 13 CHECK BOX TO EXPEDITE REQUEST- 05 F (CASH OR CHE�C/K/ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE i – z Z-0 S <br /> 1N <br /> Electronic Information: ❑List❑Map-Description: -1 <br /> FILE ADDRESS EIH_D USE ONLY <br /> Street III Street Ram city ❑ Unit f <br /> 1• �. c 5 i !-t{P��K�fc� 6 �OCt�i r-j <br /> 2. ( 2( 7 l uC�l fJ /' ❑ Unit e <br /> a. g2 ]� L`t{arrft �Ia. <br /> 4 Unit 3 <br /> 5. J <br /> 6 Unit 4 \ <br /> 7. <br /> $ ❑ unit S <br /> 9' ❑ Unk6 <br /> 10. <br /> Specific Date Range of Information Requested:From 9 to <br /> ✓ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(VST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICLE <br /> .trOTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 WASTE TIRE <br /> SrUNOERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> Zr�H�AZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 WASTEWATEF.TREATMENT PLANT <br /> �y <br /> ;+IIERED PERMITTED FACILITY D MOrEUHOTEL 0 PUMPER TRUCIdYARD/CHEM TOILETS <br /> 0 TATTODIBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> _ WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-5:0OPM - 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />