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05/14/2008 13:11 FAX 213 680 6499 BINGHAM MCCUTCHEN 2 0 001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT moo. <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone. (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ hd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: y� BUSINESS/AGENCY: -�� <br /> ADDRESS: awndV 'r r <br /> PHONE(1):2-1 tiL`LO �J L ?� PHONE(2): FACSIMILE: .2 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow ten business days from date of application submittal-•Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-k911 00 FEE CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS NT <br /> SIGNATURE OF APPLICANT DATE�J 1 IL <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ <br /> Unit t <br /> 2 ! OUnft2 1, k-7hlav <br /> _ ,---_-- nit <br /> 6. - --- — nit 4 <br /> 7. <br /> ❑Unit 5 <br /> 10. /unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH EPARTMENTyFI�LES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT A�-yO1 ID WASTE FACILITYNEHICLE <br /> A IV THER CLEANUP SITE(NON-LOP) ❑FpOD FACILITY 4NASTE TIRE <br /> JIWNDERGROUND TANK(MONITORING/REMOVAL) ID DOG KENNEL ❑DAIRY <br /> )AkflAZARCIOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑PUMPER TRUCK/YAROiCHEM TOILETS <br /> CI TA7YQ0/8QOY PIERCING 0 POOLISPA O LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM•6:00PM - 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 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 /> FHD USE ONLY <br /> EHP43ZG 10129ID7 <br /> PUBLIC RECORoy ReLEASE APP FORM <br />