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00/03/2008 09:51 FAX 53024310F" 02( HILL Z002!002 <br />DATE RECEIVED EHD LOG NUMPER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT -70 <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.o / e <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: U,w q (ar,K_ _ BUSINESSIAGENCY CH j./1 i'11'1 i <br />ADDRESS: 25 R1;f�Gt(� �i lC�d�' ;�6•i" % - <br />PHONE (1): ":3~7`Z I' 7,` '' PHONE (Z): FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: i�I IzIV15 Time: l;a <br />(Please allow ten buslness days from date of application submittal -'Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPI DITE REQUEST - $98.00F�EE�(CASH OR CHECK ONLY) - REQUEST PROCESSED IN THREE BUSINESS DAYS <br />` <br />SIGNATURE OF APPLICANT "411 i"� 0 1/ DATE CLZie'3 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # <br />Street Name <br />City <br />I ❑ Unit 1 <br />3° <br />aS. t10or.tc�ojUrl(62): <br />3y3� <br />5 «o�� trJ <br />lti1 K <br />(dw O)TP6O() q�tz <br />10 Wkttl;' Ill- <br />��'��``�0U 0_L1_ita <br />32 LI -Z <br />32ao'S <br />S. el 'Qnrarl& <br />/10 ;5 � <br />-Ih�1�-' <br />' , {4+ W(O/) ipCY5 6 j Unit4 <br />A S bk,2"U' 0 ►_-tom J ( 1I -C <br />#10 0 ceyw <br />3 10 3 2- <br />ho <br />S( C( Unit <br />. <br />12 L <br />L.lft <br />i1a nit 6 <br />CR IU <br />Specific pate Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES V <br />in.UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT �SOLIP WASTE FACILITYNEHIC E <br />u 0THER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY WASTE TIRE <br />/NDERGROUNDTANK (MONITORING/REMOVAL) ❑ DOG KENNEL 171DAIRY ��� <br />�c HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ WASTEWATER TREATMENT PLAN /// <br />17 TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑,PUMPER TRUCK/YARDICHEM ToiL <br />❑ TATTOO/BODY PIERCING POOL/SPA V LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY L� OTHER(PLEASESPECIFY) �n"t )AWL <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br />1. Llst 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) 4G4-0138 or mail to the above address. Address ranges will <br />not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will <br />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 <br />days after receipt of application. The files will be held 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 the EHD staff may not be immediately available for review. A new application <br />may be 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 />.11 EHD USE ONLY <br />EMD 4"6 10127/07 <br />PUBLIC RECORDS RELEASE APP FORM <br />