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DATE RECEIVED EHD LOG NUMBER <br /> (�pl �, • SAN JOAQUIN COUNTY <br /> HL��`"�r���\`� =-'LJ' ENVI�NMENTAL HEALTH DEPARTMERT <br /> JUL4 0 2008 600 East Main Street, Stockton, CA 95202- r <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sw.sjgov.0r `JQ <br /> EVIRON10EIJ Hl'A T'ti <br /> PEQV!f lSrrzlrlrGe PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: CL—j:�\1 �� BUSINESS/AGENCY: <br /> ADDRESS: Q �1.�X I?LkA , ?0 tom! IJ w 4� 'TY2_0 2_0 <br /> PHONE(1): (2�0 q I 9 S O')O O PHONE(2): M9 C 0 6 O N?, FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only•must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ ST-$98.00 FEE(CASH OR HECK ONLY)-REQUEST PROCESSED IN 3nBUSINESS DAYS <br /> SIGNATURE OF APPLICANT flfl� \ DATE I 0 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> r2. <br /> sa< a9 'Rd[) �. . o0 ,56 Unit 2 <br /> L Unit 3. <br /> 09 Unit 4 <br /> 6. <br /> 7. oe <br /> Unit 5 <br /> 8. <br /> 9. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) I� HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) [d�FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR Ey CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 4MOTELIHOTEL PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOOIBODY PIERCING POOLISPA RAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY Ed OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDtNG 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 /> *** If you should need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHD 4846 9/7412006 <br />