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Apr. 8, 2008 15:34 BR2VN-& WINTERS ND. 0660 P, 1/1 <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY ij <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> PIR 2 0 0 8 r600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjg v.or eh 3:51(o <br /> �_'T ;:-OYIENT HEALTH <br /> iSERVKDES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C_Cn. BUSINESSIAGENCY: <br /> ADD0$$- <br /> HONE(1)%_ <br /> PHONE(2): FACSIMILE:�__ <br /> QW <br /> TENTATIVE*APPOINTMENT DATE: q rz S70 T Time: I ,. - - <br /> (Please allow ten buSi PA"ays from da tb of apolicatlan rubmitial-*Tentative only-must be Confirmed) <br /> IM CHECK BOX TO EXPEDITE RE EST (CAS 611 CHECK ONLY)-REQUEST PROCESSED INTHREBUINESS()AYS <br /> .E 7 <br /> SIGNATURE OF APPLICANT .DAT <br /> Electronic Information: [I List[I Map-D=Ption: <br /> FILE ADDRESS EHD USE ONLY <br /> Street* stmet Name City C unit i <br /> _345 rf-h Yati ( v_hn <br /> 1-2- LA01 W61ih V% tltAell) V1 C?4D C Una 2 <br /> 3- 56CktV 7 <br /> nit 3 <br /> 4. <br /> E&&Oy� g-6u 0 C� RL) <br /> In <br /> ti. tow LA-Ae^1 2 A.) r. F it 4 <br /> 2. IoW <br /> El Unit 5 <br /> M <br /> nit 6 <br /> 10. A) <br /> Specific Date Range of Information Requested-,From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROU'No TANK(LIST)CLEANUP SRF(40P) 0 HOUSINO ABATEMENT 131115cLID WASTE FACtuTYNEHICLE <br /> ItsY'QTHER CLEANUP SITE(Nom-LOP) 13 Foon FACILITY 13 WASTE TIRE <br /> GrUNDERGROUND TANK(MONITORING[RFMOVAL) 13 DOG KENNEL 0 DAIRY <br /> MOVIAZARDOIJA WAm GENERATOR 13 CHicKEN RANCH C3 WASTEWATER TREATMENT PLANT <br /> C3 TIERED PERMITTED FACILITY E3 MOTELIHOT15L C3 PIJMPEP TROCKIYARDICHFM TOILETS <br /> 0 TATTDo/BoDy PIERCING C7 POOLISPA E3 LAND USE AiiiLkATioN SrrEs <br /> 0 MEDICAL WASTE FArjLrrY C3 OTHER(PLEASE SPECIFY) <br /> WELL ANo ftFrnc PERMIT ftcoRvs ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM.3.00PM -EXCLUDING HOLIDAYS. <br /> 1, List up to ben addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At leaSt.one file type MUST be selected. Egg tQ f2211 1§11]11.amall to tie Ak2yLaddress, 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 nofify 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 rsorgainized by EHD staff at the expense of the applicant. <br /> future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4646 1=9)07 PUBLIC RECORDS PtFLI!A$?APP FORM <br />