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10/02/2008 10: 17 FA)( ^ 001/001 <br /> Nal <br /> EHD LOG NUMBER <br /> DAM' 'll\��D) SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> T 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone; (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> E4�1VIR0N[01i�T lldE.ALTk41 <br /> PFR 01J/SMICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: v City/StetolZlp le <br /> PHONE(1): PHONE(2) FACSIMILE: <br /> TENTATIVE"APPOINTVENTDATr : Time. <br /> (Please allow 10 busldateofappl tionsubmittal-•Tentative only-must b confirmed) <br /> CHECK BOX TO EXPEDITE R FEE GAS R ONLY)-REQUEST PROCESSED IN 3 BUSIN S DAYS <br /> SIGNATURE OF APPLICANT DATE �� <br /> Electronic Infortnatlon: ❑ List Map—DesCrlpt on: <br /> FILE ADDRESS EHO USE ONLY <br /> Street# Stroat Name CI a <br /> nit 1 <br /> 1. Q R U51r-2 tJi <br /> L33. <br /> 02_� J lam' <br /> Un <br /> Unit 3 <br /> 4, <br /> 5, <br /> Ja � �.B�DI� Unit4 <br /> 6 e <br /> 7. i � Units <br /> fLL4 �9� 7 <br /> 9• Unit 6 <br /> 10. c)1y/ <br /> Specific Date Range of Information Requested:From C1110 I to �westo-�l <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT LID WASTE FACILITY/VEHICLE <br /> THEIR CLEANUP SITE(NON-LOP) to FOOD FACILITY TE TIRE <br /> NDERGROUNQ TANK(MONITORING/REMOVAL) 0 DOG KENNEL AIRY <br /> _ AZARDOUS WASTE GENERATOR d CHICKEN RANCH STEWATER TREATMENT PLANT <br /> O TIERED PeRMITTED FACILITY ❑MOYEUHOTEL MPER TRUCK/YARDICHEM TOILETS <br /> 173 TATTOo1BODT PIERCING ❑POOLISPA ND USE APPLICATION SITES <br /> ❑MEo1CAL WASM FACILITY M OTHER(PLEA9E SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORD$ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-6:00PM -ExCLUDINa HOLIDAYS. <br /> 1. List up to ten addreesoa in the space above, Select the type(z)of files from the list above by checking the appropriate <br /> box(es)- At least one file typo MUST be selected- Fax to(2091464-0138 or mail to the a dross indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received atter <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 hold 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 reviews by the same applicant may require a$106 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4046 6/04/05 PU9LIC RECORDS RELEASE APP FORM <br />