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I <br /> 5-22-08; 8:30AW..;Klelnfel Mode.StC ; 12095153444 Y t/ <br /> DATE RECE1v0€, �ti�'�i `�'• iEHD LOG NU BER <br /> L ] «I��U ��� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL WEALTH DEPARTMENT <br /> mAY 2 % 2008 600 East Main Street, Stockton, CA 95202-3029 \l <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgoV.Drg/e d <br /> EIvI`diRONNA.,EN'i iHcALTH <br /> pERt ;?;SERVICETIBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: -&P,' BUSIN/EISSIAGENCY:Z e1 d <br /> ADDRESS: �--cc <br /> PHONE(1): ' 117-V33575-3 <br /> -y7) PHONE(2): FACSIMILE: (S 3�� <br /> TENTATIVE"APPOINTMENTD TE:-Time: <br /> (Please allow ten business tla from date of application submittal-'7entae'✓e only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$ 8. D EE(CH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS D S <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street C Street NameCity \ 11 unit 1 <br /> II <br /> ..._ - -. <br /> Q, " <br /> � nit2 <br /> 3. <br /> 4, nit3 <br /> 5. <br /> 6. 0hIt4 <br /> 7. <br /> 8, 17 Unit 5 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY 11 WASTE TIRE <br /> ,M'5NDERGROUNDTANK(MONITORINGIREMOVAL) ED DOG KENNEL M DAIRY <br /> 01AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> .n I IERED PERMITTED FACILITY 0 MOTELIHOTELMPER TRUCK/YARDICHEM TOILETS <br /> O TATTOOBODY PIERCING POOLISPA 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-5:ODPM - 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(2D9)464.0138 or mall 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 applici nt <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> ERD484610118107 PUBLIC RECORDS RELEASE APP FORM <br />