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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY _ r, ���� <br /> ENVIR�rMENTAL HEALTH DEPARTMElre II Fr �VI <br /> 600 East Main Street , Stockton , CA 95202- 2708 <br /> Telephone : (209) 468 -3420 Fax : (209) 464 -0138 Web : w«rNv . sigov. org/NT 1 6 2007 <br /> pPUBLIIC { CORDS RELEASE APPLICArlP f � iv ( � � i <br /> APPLICANT: _ � K4� L1 �J /� Iy) 4 *4j BUSINESS/AGENCY: t� fcAt <br /> V 2a � V' <br /> ADDRESS : 3 \ 14 b 54aae T ACAA wdly CA , <br /> PHONE (1 ) : 2 31 ,q PHONE (2) ; eRt (M 7^ — qIz ( FACSIMILE@9 \ <br /> TENTATIVE* APPOINTMENT DATE : Time : <br /> (Please allow 10 business days from date of application submittal - * Tentative only - must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST - $98.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /°/W47 <br /> Electronic Information : ❑ List Map — Description : <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name City ❑ Unit 1 <br /> 1 • Sn N - �,DwQ/L SAc2,d /�E�✓?� �. o � L <br /> 2 . ❑ Unit 2 <br /> 3 . <br /> 4e ❑ Unit 3 r <br /> 5 . — ❑ Unit 4 <br /> 6. <br /> 7. <br /> /10Unit 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 /> , � <br /> 11 UNDERGROUND TANK ( UST) CLEANUP SITE (LOP ) HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> 13 OTHER CLEANUP SITE (NON -LOP) 13 FOOD FACILITY 0 WASTE TIRE <br /> ❑ UNDERGROUND TANK ( MONITORING/REMOVAL) O DOG KENNEL ❑ DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 11 MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOOIBODY PIERCING 11 PDOUSPA 0 LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY Q OTHER (PLEASE SPECIFY) COMPLAi eJ ` r <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 EHD staff at the expense of the applicant . <br /> Future file reviewsby 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 (209)468 - 3425 directly . Thank You** * <br />