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U7/U2/2007 MON 16:47 FAX [a 001/001 <br /> PATE;kEQ,Eyf,p <br /> SAN JOA EHD LOG NUMBER <br /> QUINCOUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E.Main Street, Stockton, CA 95202-3029 <br /> -007 Jelephone:(209)468-3420 Fax: (209)464-0138 Web-,WWW.Sjg0v.0rg/e <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Lt/q v., lte i. <br /> BUSINESS/AGENCY: r-tzrl C*--) <br /> ADDRESS: <br /> PHONE(1), PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: J L-C. Y I I 7-C- TIrn.: U a I Y--) <br /> (Please allow 10 business days from date of applicklon submittal-*Tentative only-muet be CQnflynne4) <br /> ❑ CHECK BOX TO EXPEDITE R QUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE '7 <br /> Electronic information: [_1 List E] Map—Description: <br /> FILE ADDRESS EHD USE.PN.LY <br /> Street III -Street Name city <br /> unit I <br /> 2. Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 5 6. <br /> . ;00�Unit4 <br /> 7. <br /> 9. <br /> 0 <br /> Specific Date Range of Information Requested:From A-L to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> GKUNDERGROUND TANK(UST)CLEANUP SITE(LOP) r3 HOUSING A13ATEMENT mrsauo WASTE FACILITYIVEHICLE <br /> E;KbTmr;R CLEANUP SITE(NON-LOP) 0 Fool)FACILITY WASTE TIRE <br /> Fr-vNnrRr,RouND TANK(MONITORING/REMOVAL) 0 DOG KENNEL C3 DAIRY <br /> Lg-HAZAROOUS WASTE GENERATOR 0 CHICKEN RANCH r�,YWASTZWATER TREATMENT PLANT <br /> M?'fIERED PERMITTED FACILITY 12 MOTEL/HOTEL 0 PumveR TRUCKIYARD/CHEM TOILETS <br /> 9JATTO01BODY PIERCING M OOLISPA M-tAND USE APPLICATION FITER <br /> 0 MEDICAL WASTE FACILITY WCOTHER(PLEASE SPECIFY) 'ye-P-k('(f , t)r'l VrA4i_- L'L'V_'0 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AvAiLAIKI!FOR REVIEW- MONDAY-FRIDAY 9'00 Am-5,00pm - EXCLUDING HOLIDAYS. <br /> 1. List up to ton 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 12091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file 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(110) <br /> days after receipt of application. The files will be hold 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 now application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the game 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 /> UND 48-09 9113t2ODB wab <br />