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209-234-0536 Line 1 � 16:03 05-06-2008 1 11 DATE RECEIVE=D EHD LOG NUMBER SAN JOAQUIN COUNTY E� -}` W E F ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 MAY 0 7 2008 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.$)gov.orgl q, ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION APPLICANT: SS 11 ACLt-10 /1-21/_ _BUSINESSIAGENCY: rowValf, ADDRESS: f�J` O /f4''?K ��S f �'�CrI� L)/"-j-C `Z7 PHONE t): . h�z ` �� PHONE(2): FF�� FAG5IMI EA �4� P TENTATIVE*APPOINTMENT DATE: _/�� lJC�i ©O Time: (Please allow ten business days from date of a plication submittal-*Tentative only-must be confirmed) CHECK BOX TO EXPEDITE REQUEST-$98.0 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS SIGNATURE OF APPLICANT DATE 5" Electronic Information, ❑ Lis Map-Description: FILE ADDRESS EHD USE ONLY Street# Street Name City / ❑Unit 4 Ave, 4 3. Tm _ Unit 3 6. nit 4 7. 13. ❑Unit s 9. 10. Unit 6 Specific Date Range of Information Requested:From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT XSOLID WASTE FACILITYNEHICLE OTHER CLEANUP SITE(NON-LOP) ❑FOoD FACILITY ❑WASTE TIKE UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL 0 DAIRY HAZARDOUS WASTE GENERATOR El CHICKEN RANCH 0WASTEWATER TREATMENT PLANT ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRIICKIYARDICHEM TOILETS ❑TATTOO/BODY PIERCING ❑POOLJSPA RAND USE APPLICATION SITES ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) WELL.AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00pM-EXCLUDING HOLIDAYS. 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to 209,)464-0138 or mail to the above address. Address ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EMD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten days after receipt of application. The files will be held for a maximum of five business days for review, Appointments should be scheduled accordingly. 3. A file that is actively being worked on by the EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$98.00 deposit prior to review. EHD USE ONLY G Fun An.ns:1N}O1f17 PUP-1 f:RPt'.0RnA OFl FAAF APP MRn1