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�i='� SAN J `l� .IOAQUIN COUNTY EHD LOG NUMBER <br /> NOV 13 2008 ENVIRONMENTAL HEALTH DEPARTMENT � ��h ..y <br /> 600 East Main Street, Stockton, CA 95202-3029 � / r/ <br /> EPdVIROtif1�EIV'i HEAT,�Fllephone: (209)468-3420 Fax: (209)464-0138 Web: WWW.sjgov.org/ehd I v <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: re. mo City/State2ip <br /> PHONE(12- PHONE(2): <br /> - FACSIMILE: <br /> TENTATIVE' <br /> APPOINTMENT DATE: . ; // /h� Time: Gf�WI <br /> (Please allow 10 business days from!date of applicatiom submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU $105 FEE(C CH/EJCK,ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4LY DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City <br /> 1. rr E] Unit 1 <br /> 2. 3 A r h n K /��96� ❑ Unite tk <br /> 3. <br /> 4. UC II 9cl`�✓ unita T <br /> 5. <br /> A <br /> 6. © vii it <br /> T. v rL <br /> 6. <br /> ❑ Unit 5 <br /> U . /-F <br /> It <br /> 10. ElUnit 6 <br /> Specific Date Range of Information Requested. From I - to <br /> �y <br /> ENVIRONMENTAL HEALTH EPARTMENT FILES <br /> 34 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑SOLID WASTE FACILRVNEHICLE <br /> A. OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> K UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> MHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IM TIERED PERMITTED FACILITY 171 MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑ POOLISPA M LAND USE APPLICATION SITES <br /> M MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-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 1'209)464.0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance::with flle,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 beheld 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 Nle reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04/06 <br /> PUBLIC RECORDS RELEASE APP FORM <br />