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APR-13-2004 03:32P FROM: 4640138 P.2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> a II _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> E <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eha <br /> al <br /> U-ice 0 2006 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> EN <: - e 4 o� ,v <br /> '�,� BUSINESS/AGENCY:t�/'dd�/Q� '4 <br /> ADDRESS: �y7 ' D_ <br /> PHONE(1): `/ Oa / 3 PHONE(2): / FACSIMILE: iv aW 9 <br /> 7-41,1,1 <br /> TENTATIVE*APPOINTMENT DATE: Time: ! ,� <br /> (Please allow 10 business days from date of application submittal•'Tentative only-must be confirmed) <br /> CHECK BOX 70 EXPEDITE REQUEST-$95.00 FEE ASH OR CHECK O -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE A <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1. d ra �/� ha F t! <br /> 2. i I/ // t..(,ST t)Li ❑ Unit 2 <br /> 3. <br /> 4 Unit 3 <br /> 5. VY <br /> Unit 4 <br /> 6. <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. or--- ri � ir) Unit 6 <br /> 10. {l <br /> Specific Data Range of Information Roquest :FAM, 4 to <br /> C <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> YNUNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 17 CHICKEN RANCH (O WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE'FACtU Y 0 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 typo MUST be selected. Fax to(209)484-0138 or mall 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 filo 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 48-06 9/19/2006 <br />