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J 06/10/2008 13:35 FAX 559 256 1478 URS FRESNO [t3j001 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> i(' li)' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 660 East Main Street, Stockton, CA 95202-3029 <br /> 7,�plephone: (909)468-3420 Fax: (209)464-0138 Web: www.sjgov.or 5 �7 <br /> s <br /> 1 <br /> PLMLIC RECORDS RELEASE APPLICATION <br /> l,"irr' ,t..t,� BUSINESSIAGENCY:APPUdAkTt ".1 <br /> 5 W� dna' dM <br /> ADDRESS: 40 Cut ar l,Jq 1��1 1ZS � Q✓� � 7ZU <br /> PHONE(1): 41,6 r PHONE(2): 30` 487ip FACSIMILE: tSC —;Zy6 - /L179 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow ten buc'ness days from date of application submittal-'Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE RE(UEST-$98.OqFEE(CASH R CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> ; _. DATE �l�dlae <br /> Electronic Information: ❑ List❑ Map-Description: <br /> w <br /> FILE ADDRESS EHD USE ONLY <br /> F4. / <br /> et# teet Name city ❑Unit 1 <br /> l4. adoa �R.� Unit 2 <br /> S /`{ Qd��tZ. AZ. S OGIL�GN D\1ll��S(�A'� bGIL T-6 h4nit 3'71c blv` otto_i cT4�— – S l � _ �i <br /> 6. _100 lM`Ctpv "Auc, �$TOcat-T�l-� <br /> /Init4 <br /> 7. GN -- <br /> 8. DLCrIUY `,+ J Cz s l Oc(Cj ON ❑Unit 5 <br /> 9. 350 / '0.J f I 1 <br /> ❑Unit 6 <br /> 10. 3,51�4c�T <br /> Specific Date Range of InformatiorR quested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4DERGROUND TANK(UST)CLEANUP SITE(LOP) In HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> 12'C�THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> W/ DERGROUND TANK(MON ITORINGIREMOVAL) 13DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 11 MOTEUHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑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:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the:,pace above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type hIIUST be selected. Fax to(209)464-0138 or mail to the above address. Address ranges will <br /> not be accepted-for add itionaiassistance 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 applicatj 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 wort'ed 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 /> EHD USE ONLY <br /> EHD 48 DG 10129107 PUBLIC RECORDS RELEASE APP FORM <br />