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DATE RECEIVED EHD LOG NUMBER <br /> o ((�� (cam l��I����� SAN JOAQUIN COUNTY <br /> IC�LSI! 1J ELD ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> AUG 2 2 2007 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.s�go r I <br /> ENVIRONMENT HEALTH 5 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: DOA) CP,61-1V V BUSINESS/AGENCY: <br /> ADDRESS: //P o. Oax 37V4 /itg1-OGS{ Cf_9S.30/ <br /> PHONE(1): (0 1;0-lei'03 PHONE(2): -402 -!'fo S Z FACSIMILE: to(o S-2598 <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 RE QU $98.00 E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9 - Z2--C7 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY 1.010 <br /> Street# Street Name City4-- e <br /> Unit 1 <br /> 1. <br /> 188 9 / W CL �E N2 8 CGE nEN ( Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> 5. R4 <br /> 6. <br /> 7. <br /> ❑ Unit 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 /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FYOUSING ABATEMENT I�SOLID WASTE FACILITY/VEHICLE <br /> 13 OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL 1UMPER TRUCK/YARD/CHEM TOILETS <br /> 1:1TATTOO/BODY PIERCING El POOL/SPA L�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-5:00PM - 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 reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHD 48.06 9/14/2006 <br />