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07/07/2008 11:56 FAX 559 256 1478 URS FRESNO 0 001 <br /> DATE RECEIVED\I �. EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> j._ Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or <br /> �f:Ry403 <br /> I -S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: kL- BUSINESSIAGENCY: NQS CO(Lpd(L�6'�Qr P <br /> ADDRESS: (L ' 4 0190 49-41gb 2-0 <br /> PHONE(1): -- X _ PHONE(2): s��— a-'S'f3Zc FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow ten business days from date of application submittal-'Tentative only-must be confirmed) <br /> 17 CHECK BOX TO EXPEDITE REQUEST-$96.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7/-710 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑Unit 1 <br /> 1 0V PE 4T 1 ST04, *root <br /> 2. ❑Unit 2 <br /> 3. \1�1� <br /> 4. nit 3 <br /> 5. <br /> 6. <br /> nit 4 <br /> 7. <br /> 8• O Unit 5 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested:From _4U— to <br /> �,// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> MV <br /> CLEANUP SITE(NON-LOP) El FOOD FACILITY 13 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 13 MOTEL/HOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 11 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 6:00 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(2091464-0138 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 /> EHD USE ONLY <br /> EHD 48.08 10129/07 PUBLIC RECORDS RELEASE APP FORM <br />