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—<- 06/22/2007 11:49 1310798^-,I1 PAGE 02 <br /> DAT R,RCEIVED; n, —�^ EHD LOG NUMBER <br /> SAN JO.A,QUIN COUNTY <br /> ENVIRONiWNTAL HEALTH]DEPARTMENT r %��� <br /> N07 600 E. Main Stxeet, Stockton, CA 95202-3029 <br /> N Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.l jgov.or&bd <br /> ;Vk ES PUBLIC RECORDS RELEASE APPLICATION <br /> :i <br /> APPLICANT: A:Udd' 0'59 Ilt�� BUSINESSIAGENCY: <br /> ADDRESS: ZgC7(_) C-a�t�.- drl� fc h3c� a W,,I--t" :f,.< IC./ C 4 <br /> PHONE(1): C�.1 1 % Z 1� PHONE(2):_� c�T� i�� ��h�� FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Tlme: <br /> (Please allow 10 business days from date of application submittal-"TentariVa only-must be confirmed) <br /> © CHECK BOX TO EXPEDITE REQUE 5.0 (CASH OR C Y)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 6fZ -- <br /> Electronic Information: El List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 5 11` r'GtL T <br /> 2. h rZ, ✓ Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> 5. <br /> Unit 4 <br /> s. <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 /> 1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT XSOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ;WWARTEWATER TREATMENT PLANT <br /> 'TIERED PERMrrTED FACILITY ID MOTEUHOTEL ❑ PUMPER TRUCKiYARD1Cri1=M TDILETs <br /> 0 IFATTOOiBODY PIERCING D POOLiSPA ❑ LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIrY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AMS:DoPM - FXCLUoINo HOLIDAYS. <br /> 1. L.Ist 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 he selected. Fax 19 f20$1 4§4&UE orMall to tb",c[dress_indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the FHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant)f 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 /> 1 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 /> EHD USE ONLY <br /> PHD/sae W13ROQ6 web <br />