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DATE RECEIVED EHD LUG NUMBER <br /> p J� ` SAN JOAQUIN COUNTY 1'LLQ ' V'k Q) ENVAk'dNMENTAL HEALTH DEPARTM <br /> 600 East Main Street, Stockton, CA 95202-2708 <br /> APR 16 008 Telephone: (209)468-3420 rax: (209)464-0138 Web: www.sjgo�.or 5 <br /> ENVIRONMEN'i riEALI"H 4 <br /> PERP0 I I^c w PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: "t r <br /> BUSINESS/AGENCY: <br /> ADDRESS: ` Z.b ii <br /> PHONE(1): 'll�� ?j PHONE(2): �U, a ��- FACSIMILE: I <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 171 CHECK BOX TO EXPEDIT QU - .00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE M <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. Z . <br /> 2. �. w <br /> C� � Ir,/C unit 2 <br /> 3. <br /> 4. nit3 <br /> 5. I ' <br /> 6. fQ#Unit a <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tHERDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> CLEANUP SITE(NON-LOP) 11FOOD FACILITY WASTE TIRE <br /> 2NDERGROUND TANK(MONITORING/REMOVAL) 13 DOG KENNEL 17-1DAIRY <br /> AZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 1]WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 11 MOTEL/HOTEL ❑ MPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ZI LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <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 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(10) <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 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 El-ID 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 /> *** If you should need further assistance please contact Diane Martinez C (209)468-3425 directly. Thank You*** <br /> EHD 48-06 9/14/2006 <br />