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07/22/2009 WED 15: 00 FAX 200 -92999 SSC Public Works 01001/001 <br /> I a. <br /> I <br /> �!--- iL SAN JOAQUIN COUNTY t �� <br /> ENVIRONMENTAL HEALTH DEPARTMENT r <br /> JUL 1/ 2 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> _'N l�li'tiiV„i�i`�; P�LTN <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> j +�F <br /> PE ''`5 T S'_�R V S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> ADDRESS: , —BUSINESS/AGENCY: SA P (,A/ <br /> �d/�� HGl ZL°� <br /> CitylState/Zip CC <br /> PHONE(1); PHONE(2): _ �fdn �' �1 —j_✓ <br /> FACSIMILE: _Y6���QQ9 <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-*Tentative o*-must be confirmed) <br /> CHECK BOX TO EXPEDITE MOS.FEECASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _— <br /> DATE 7.Z;;7, <br /> Electronic Information: ❑List❑Map—Description: <br /> _ FILE ADDRESS <br /> Streets Street NameEHD USE ONLY <br /> I 1 —p— �- �City - --- - <br /> I 2. I Zc/ <br /> (✓ tl0 U/►t L] Unit 1 <br /> i � o«la�� I <br /> s. 3 70 / 'z <br /> othlai (� <br /> S. 1 f 1 rG _ 1 Unita <br /> 6.7. <br /> Unit 4 <br /> 8. <br /> 9. <br /> — --- Unit 5 <br /> 10. <br /> J ❑ Unit 6 <br /> Specific Date Range Of Information Requested:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Fn, <br /> �NDERGROUND TANK(UST)CLEANUP SITE(LOP <br /> XOTHER CLEANUP SITE(NON-LOP) ) 10HOUSING ABATEMENT <br /> P1NDERGROUND TANK(MONITORING/REMOVAL 0 FOOD FACILITY 0 SOLID WASTE FACILITYNEH(CLE <br /> HAZARDOUS WASTE GENERATOR ) M DOG KENNEL 0 WASTE TIRE <br /> TIERED PERMITTED FACILITY 0 CHICKEN RANCH DAIRY <br /> TATTOO ❑MOTEUHOTEL 0 WASTEWATER TREATMENT PLANT <br /> MEDICAL <br /> WASTE FACILITY 0 PooUSPA �4PUMPER TRUCK/YARD/CHEM TOILETS <br /> � ASPIERCING <br /> O OTHER(PLEASE SPECIFY) AND USE APPLICATION SITES <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 <br /> box(es). At least one file type MUST be selected. Fax t type(s)09414-0138 or maf files from il tlo4th address ndi ated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. Applications ret above by checking the ceived after <br /> j 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 <br /> days after receipt of application. The files will be held for a maximumof five bus businessdays for be review. Appointments <br /> should be scheduled accordingly, , ten(10) <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew appl eation may be <br /> submitted when the fife n 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$105 deposit prior to review. <br /> IEHD USE ONLY <br /> IEHD 48-06 8/04/08 <br /> PUBLIC RECORDS RELEASE App FORM <br />