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12/19/2007 11:08 2133800505 ENVIRONMENTAL PAGE 01/01 <br /> _DATE RECEIVED {� �J <br /> EHD LOG NUMBER <br /> ID) M '�//� SAN JOAQ IN COUNTY <br /> ,' 10 <br /> ENVIRONMENT,AL HEALTH* DEPARTMENT <br /> 304 East Weber Avenue, 3`a Floor, Stockton,CA 95202-27 <br /> ZI(Z//�/ <br /> .1. 9 2007 Telephone: (209)468-3420 Fax-, (209)464-0138 Web: www.sjgoy.org/ <br /> ENV1 R 0['4i� El°THE PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: n. r Vi BUSINESS/AGENCY: _ 1 <br /> ADDRESS: q <br /> PHONE(t);-a 12- U�!-}_ 22L `_ PHONE(2): _ � FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please Allow fo business days from date of application submittal-'Tentative only-must be confirmed) <br /> 1� CHECK BOX TO EXPEDITE REQUEST-69s.00 rE'E(CASH OR,CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /. . I� DATE <br /> Electronic Information: ❑List❑Map,Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> - ❑ unit 1 <br /> �. 9 <br /> c, <br /> 2. _ ❑ unit 2 <br /> 3. <br /> 14. Unit 3 <br /> 5. <br /> 6. <br /> 7. <br /> N <br /> Unit 6 <br /> Wo <br /> ❑ unita <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(U$T)CLEANUP SITE(LOP) O HOUSING ABATEMENT 0 SOMP WASTE FACILITY/VEHICLE <br /> fOTHER CLEANUP SITF INION-LOP) 11 FOOD FACIL1Ty C1 WASTE TIIte <br /> WC I l'_5 (MONITORING/REMOVAQ Q Doo FENNEL Q DAIRY <br /> lv­VUUS WASTE GENERATOR ❑CHICKEN RANG" Q WASTEWATER TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑MOTEL/HOTEL 0 PUMPER TkUCK/YARD/CHEm ToiLETs <br /> E3 TATTOO/BODy PIERCING ❑POOL/SPA Q LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY OTHER(PLEASE SPEctFY) ,g <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEw- MONDAY-FRIDAY 8:00 A �6;DOPM - 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. Fa2g to(2001464-0138 orimail to the address Indicated aboye.. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the END.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 /> EHD 48.08 9/7agWfi <br />