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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQ M COX3N'][�Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3'd Floor, Stockton,CA 95202-2708 <br /> A 3 - 5 2007 Telepbone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.or&h qt 3 <br /> E'N1i;;��i%iir};'�i'vf �-Ii=ACTH <br /> r , PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: S67T—i G LAST-{ _ BUSINESS1AGyENCY: •leou V, Astor_:Lm� � <br /> ADDRESS: S RA-F Te-P— S'PTLL'-T - S L b l <br /> PHONE(1)' 2-21A-0 CA 0.0 - PHONE(2): <br /> TENTATIVE"APPOINTMENT DATE: _Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> El CHECK BOX TO EXPEDITE RE T-$35.00 ;=.ECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �b <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name City © Unit 1 <br /> 2' �D20 O d © Unit2 <br /> 3. <br /> 4. Unit 3 <br /> S, Unit 4 <br /> 7. <br /> $. ❑ Unit 5 <br /> 9. <br /> 10. © UnIt6 <br /> Specific Date mange of Information Requested:From l e F to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> ���rrrCITHER CLEANUP SITE(NDN-LOP) 13 FOOD FAc1uJTY 13 WASTE TIRE <br /> UNDERGROUND TANK(MONITOWNG/RemovAL) ❑DOG KENNEL a DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERu1TTEo FACILITY 0 MoTELIHOTEL E3 PUMPER TRUCK/YARWCHEM TOILETS <br /> ❑TATroo/BoDY PIERCING C3 POOL/SPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY C3 OTHER(PL LASE SPECT ) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MOND I' -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)484-0139 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 fifes exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximunj 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$95.00 deposit prior to review. <br /> END USE ONLY <br /> EHa 48-06 9l44l20D6 <br />