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5-22-08; d:30AM;V:l einfel Isotles tC 2095753444 <br /> DATE REC I EHD LOG NUMBER <br /> ��;_� J� <br /> vSAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> L. 9, 2008 600 East Main Street, Stockton, CA 95202-3029 '2 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e d� <br /> ENN'ROiks` Nil HEALTH <br /> PER F11/�EQV!CFEIBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C`dvF' �;22(C BUSINESSIAGENCY \ <br /> ADDRESS: ';IQ 0-' d (l 9535 <br /> PHONE(1): 1x-7.7 ,3J! / -U � PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENTD TE: Time: <br /> (Please allow ten business da from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$ a. 0 EE(C H OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FF <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑unit 1 <br /> 1. <br /> z. <br /> 3. oillp .11:2 <br /> 4. \ <br /> 5. ybnita <br /> 6. /./ <br /> �Ihlt a It <br /> 7. <br /> 8. <br /> 12 Unit 5 <br /> 9. <br /> 10. ❑unit 6 <br /> Specific Date Range of Information Requested: From to <br /> J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> An UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> xOsTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> r <br /> � VNDERGROUND TANK(MONITORING/REMOVAL) C3 DOG KENNEL 11DAIRY <br /> ;3_9AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH C WASTEWATER TREATMENT PLANT <br /> ,21IERED PERMITTED FACILITY ❑MOTEUHOTELplpMPER TRUCKIYARD/CHEM TOILETS <br /> 0 TATTOOBODY PIERCING 0 POOLISPp LAND USE APPLICATION SITES <br /> C MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 5:00 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 type MUST be selected. Fax to 1209)464-0138 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with fit.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 applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD49-00 10119101 <br /> PUBLIC RECORD.RELEASE APP FORM <br />