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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENV ONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.or <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_�- ' nc�VV�; irk j.S'} ,�n} �L BUSINESS/AGENCY: <br /> ADDRESS: iau 1� l(A L"� r CITYISTATE/ZIP <br /> PHONE(1): PHONE(2): FACSIMILE: <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 REQUEST-$105.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. S. t u, `i S1 Ic,� <br /> 2• - unit 2 <br /> 3. A (�? I-T 9 <br /> 4, ❑ Unit 3 <br /> 5. <br /> 6. <br /> Unit 4 <br /> 7. <br /> $ — Q Unit 5 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 11 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE/' <br /> 13 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> 11 UNDERGROUND TANK(M ONITORING/REMOVAL) 13 DOG KENNEL 11 DAIRY <br /> I] HAZARDOUS WASTE GENERATOR El CHICKEN RANCH C3 WASTEWATER TREATMENT PLANT <br /> 11 TIERED PERMITTED FACILITY MOTEL/HOTEL O PUMPER TRUCKNARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 113 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 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(20 9)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$105,00 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 <br /> 8/04/2008 <br />