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May 15 08 12:25p Paul Humphrey (55c` ')26-3408 p.1 <br /> M, <br /> lU�u<IL�� SAN .10AQUIN COUNTY CHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> fr'AY 1 5 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> M`JIRG!VMENT HEALTH Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: ww%v.sjg v.D <br /> 5?10 <br /> PERmi-i1SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: `IOG7 _ C �;'rl �>'L _�/f'1 .-() e:�14 <br /> PHONE(1): PHONE(2). FACSIMILE: `) 2 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow ten business days from date of application submittal-"Tentative only-must be conffrmgtt).' <br /> yHECK BOX TO EXPEDITE REQUEST-$9&00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN TH <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 /> l d/;_1ci� <br /> 2. Z 6 it 2 <br /> 3. 2735 <br /> _ r� --- -- <br /> 4- ?`� 0 �7 t✓ r cit 3 <br /> 5. pt J1 C.. / j�� �� <br /> f -7 <br /> 6. -- -_ nit 4 <br /> 7. <br /> 8- ❑Unit 5 <br /> 9. r7r <br /> 10. nit 6 <br /> Specific Date Range of Information Requested:From to ?�/ <br /> ENVIRONMENTAL PARTME S <br /> 15UNDERGRou,ND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ATEMENT LID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) El FOOD FACILITY WASTE TIRE <br /> 25�UNOERGROUNDTANK(MON ITORINWREMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATDR ❑CHICKEN RANCH W WASTEWATER TREATMENT PLANT <br /> -TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPERTRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING C7 POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REAEw- MONDAY-FRIDAY 8:00 AM-5:00Pht - 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 above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <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 the EHD staff may not be immediately available for review. A new application <br /> may be 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 /> i <br /> I I <br /> EHD4846 10122rw PUBLIC RECORDS RELEASE APP FORM <br />