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5-22-0a; 6:3OAM;11IelcPejde, MOd P.stC _ <br /> •� _ 120o5i5;C44 <br /> DATE RECE,IRE �� EHD LOG UMBER <br /> LKS L�� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAY 2 2 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> nr Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e d� <br /> Ei�,`vi3'DI NIEN HEALTH <br /> PERAR;T/�'?ERVICP_ IBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �CFt. �(C a BUSINESS/AGE CY; <br /> ADDRESS: .��7 aeZ b l <br /> PHONE(1): ",J/7�V��Z PHONE(2): -7 <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT D TE: <br /> (Please allow ten business da fronly date of application submittal-'Tentative onTime:y-must be connrmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$ S. 0 EE(C H OR CHECK ONLY).REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street at Street Name <br /> City Unit 1 <br /> 2. <br /> 3, nR 2 <br /> 4. <br /> 6. nit ` rl <br /> 6. �l1 <br /> T. It 4 <br /> 000, <br /> B. <br /> 9. <br /> ❑Unit S <br /> 10. <br /> O Unit 5 <br /> Specific Date Range of Infomlation Requested: From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 'E7 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑ <br /> OTHER CLEANUP SITE(NON-LOP) ❑ SOLID WASTE FACILITYNEHICLE <br /> r�� FOOD FACIUKENNEL <br /> ❑WASTE TIRE <br /> Ja-QNOERGROUNDTANK GENERATOR <br /> 13 DOG KENNEL ❑ DAIRY <br /> WASTE GENERATOR ❑CHICKEN RANCH <br /> .e TIERED PERMITTED PACILIN ❑WASTEWATER TRUcKREA DICHEM TOIL <br /> ❑TATTOO/BODY PIERCING ❑MOTEL/HOTEL ❑ MPER TRUCKNgRO/CHEM TOILETS <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(n �D USE APPLICATION SRES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM- ; <br /> 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 f2D91464.0138 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications recelved 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 to <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$98.0D deposit prior to review. <br /> END USE ONLY <br /> D 4A-O6 10l]6bT <br /> PUBLIC RECORDS RELEASE APP ORM <br />