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oAr�AP . 23u 2008 11 : 03AM A Hanced Geo ronrnental No, 1$3OEHo�__1.vu�lr3El� <br /> SA,N.�QAQ IN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Z' LCiC� Telephone: (209)468-3420 Fax: (209) 464-0138 Web:WWw.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; � '-- - ✓f'C4y G�6� ._SU$INESSIAGENCY: W va'"ce(� 6; e - <br /> ADDRESS: r� �l� tJ` r•G.e�G*.�' <br /> PHONE(1): I / t PHONE(2)...,. 6( � �O '. /� —FACSIMILE; ..,..,..,..., <br /> TENTATIVE=APPOINTMENT DATE. Time. f <br /> (Plsase allow 10 business days from date of application submittal-'Tenfaflve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUE -$98.00 FE {C,45M OR CHECK ONLY)•REQUEST PROCESSED 1N 3 f3U$INE88 DAY <br /> SIGNATURE OF APPLICANT s . DATE Z -tJ <br /> Electronic Information: ❑ List❑ Map-Description; <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name - City ��. ❑ Unit 1 <br /> 2. C3s _f�S7 �t�"c'> ' 4) , l�; © Unit <br /> 3. Q 7 sr lilt?4­eie, <br /> Unit 3 <br /> r,a p r <br /> 7. <br /> _. ._.... - Unit a- <br /> 8. <br /> 9. <br /> - .... .- - Unit 8 <br /> 14. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4!1_1U1'NDERGR0UNP TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT -►K6un WASTE FACUTYtvEH3CLE <br /> 17 OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> EKNDERGROUND TANK(MONITORINOIREMOVAL) ❑ DOG KENNEL ❑DAIRY <br /> 4"AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTELrHOTEL M.PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATT001BODY PIERCING ❑POCUSPA ❑ LAND USE APPLICATION SITE$ <br /> M MEDICAL WAs7E FACILITY ❑OTHER(PLEASE SPECIFY) r_ <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 209 464.0138 or mail to the address Incilcated 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 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 flve business clays 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 /> s <br /> EHD 48-06 WEB 9IR2007 <br />