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f-f?-2154 KLEINFELDER 40:48 03-18-2009 112 <br /> r� Ir � I HD LOG N MB <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �' <br /> , �" W <br /> `,Telephone: (209)468-3420 Fax: (209)464-0138 Web: WW.sjgov.org/e <br /> -'.N <br /> PUBLIC RECORDS RELEASE APPLICATION II <br /> APPLICANT: BUSINESSIAGENCY: Q� <br /> ADDRESja <br /> S: I'o �Cn <br /> nA <br /> PHONE(1): L,? f ^t�3� PHONE(2): �q _FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: l Time: <br /> (Please allow ten business days fromto of application submittal-'Tentative only-must be confirmedi <br /> CHECK BOX TO EXPEDITE REQUEST-$98.00 F E CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUST ESS DAYS <br /> SIGNATURE OF APPLICANT DATE _ <br /> Electronic Information: ❑List❑ Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street* Street Name <br /> �� CI ❑Unit i <br /> F-3. <br /> nit 2 <br /> � <br /> 4. � - <br /> --_ �nit 3 <br /> 5. <br /> 6. <br /> - nit R <br /> 7. <br /> 8. - - <br /> _ ❑Unit 5 <br /> 9. <br /> 10, o s <br /> Specific Date Range of Information Requested:From to <br /> ,,// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ZNOERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT -SP, WASTE FACILITYIVEHICLE <br /> HER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY WASTE TIRE <br /> DERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAI Y <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ID-WASTEWATER TREATMENT PLANT <br /> 13-TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑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-6:00PM - 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 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 4e-0e 10128107 <br /> PUBLIC RECORDS RELEASE APP FORM <br />