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0" 10/2008 WED 12: 17 FAX 2099480806 2001/001 SAN JOAQUIN COUNTY EHD LOG NUMBER SSP 0 2008 ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 EIv JIF1Ui�f'4 I� 1 r1E.I\;T HEALle,lephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/eh PEPJI!i;aE.RVICES PUBLIC RECORDS RELEASE APPLICATION APPLICANT: 01 7�Lin BUSINE5S/AGENCY: i j tV SSI�'1�D ADDRESS: C 11V Syl i ";�t-t City/State/Zip -.1:36 7ot �3a PHONE(1): N `14"sz PHONE(2): � Sq��13--7b6-] FACSIMILE: "c?7: TENTATIVE*APPOINTMENT DATE: As 5eino AS Time: (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) CHECK BOX TO EXPEDITE REQUEST-$1A5 FEE SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS AYS SIGNATURE OF APPLICANT �- DATE 13 Gig Electronic Information: ❑List❑Map-Description: FILE ADDRESS EHD USE ONLY Street# Street Name city U' 1. -713 {`r ri- --- - —G 105� nnit 1 2 `JtCiG UKnit2 1 3. Y 4. nit 3 5. I 6. ----- Unit 4 7. 6 Unit 5 g. Unit 6 10. I fi Specific Date Range of Information Requested: From _ a Lt- to f ENVIRONMENTAL HEALTH DEPARTMENT FILES ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE 17 OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE IY/tn�Gf//C�fyCJ G ❑UNDERGROUND TANK(MONITORING/REMOVAL)N ❑DOG KENNEL ❑DAIRY ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS ❑TATTOO/BODY PIERCING C).L ❑POOLISPA `�11 ElLAND USE APPLICATION SITES I El MEDICAL WASTE FACILITY b4. KOTHER(PLEASE SPECIFY) A1.L- f WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will be processed the next business day, 1 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. i 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be i submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$105 deposit prior to review. EHD USE ONLY I. EHD 48.06 6104/08 PUBLIC RECORDS RELEASE APP FORM I