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05/10/2008 09:54 9164 '803 MATT PAGE 01 <br />DATER CEIVED EHD LOG NUMBER <br />SAN .10AQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />R <br />600 East Main Street, Stockton, CA 95202-3029 �, L� L _ <br />�;� <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/e d <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: tq 17 RUSINESSIAOENCY: <br />ADDRESS: -?I-Lt. N c__j �j d'_/X JUES <br />PHONE (1):. q1 L• 4'4-6_ 1?():5 PHONE (ZI: FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: S `Zq��IT Time: °i 30 H^1 <br />(Please allow ten business days from date of application submittal -*Tentative only - must ba conflrmed� <br />© CHECK BOX TO EXPEDITE REQUEST�- $99-00 FEE JCASH OR CHECK ONLY) - REQUEST PROCESSED IN THREE BUSINESS DAYS <br />SIGNATURE OF APPLICANT `?" DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS_ <br />- EHD USE ONLY <br />0 Unit 1 <br />, 1 <br />Street# <br />Street Name <br />City <br />,. <br />r 0 <br />w(i"s0A) wfly 5 _ <br />5rUCK70n1 <br />2. <br />116() <br />Lj. YUSg^tl fivp_-uC <br />MAN-'-f_�c.,4 <br />17]Unit2 <br />4je, TJ S <br />3. <br />4. <br />-- <br />1515 <br />CNR2rr2 W�Yr <br />L7 <br />57-0C"11i <br />6. <br />P2L�vuj' <br />Unit4 <br />7. <br />Fl A2U/ tJ W,�Y <br />7 /� <br />a ./H NE0t!(?9 11,gf6 /q ❑ unit <br />L107-1 <br />T <br />❑ Unit 6 <br />Specific Pate Range of Information Requested. From /q L(_ to P2e'5&J; <br />ry,.� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />P/�,I'' UNDERGROUND TANK (UST) 13T) CLEANUP SITE (LOP) HOUSING ABATEMENT ❑ SOLt0 WASTE FACILITYNEHICLE <br />,KOTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY M DAIRY TIRE � ' n _I f <br />UNDERGROUND TANK (MONITORtNG/REMOVAL) 173 DOG KENNEL ❑DAIRY V�'l. I •Jj' <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Q WASTEWATER TREATMENT �{ p <br />TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS �/ / �i G 7 /VCS <br />❑ TATTOWBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION ITES k <br />EIMEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) t=yAlY7/l,�l+FiP�D -To E <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-6:00PM - 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 above address. Address ranges will <br />not be accepted - for additional asslstance 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 he 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 />1 - 6-1 - W <br />EHD 48436 13121107 PUaLIG RECORDS RELEASE APP RDRM <br />