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OAl�2�L�E�V�� <br /> PD <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> I ii 2008 ENVIRONMENTAL HEALTH DEPARTMENT <br /> Fi.f`JIP�!',1(�1p1 j ;��+ 600 East Main Street, Stockton, CA 95202-3029 <br /> jeephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgay. <br /> o6 <br /> q, <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: -� �,1 61 BUSINESSIAGENCY• <br /> ADDRESS: !� r�Sil ' a vc�• City/State/Zip / oz-) 9 J 6']Z <br /> PHONE(1): �le�C�`l PHONE(2): "al z �� FACSIMILE: lol ] c <br /> TENTATIVE*APPOINTMENT DATE: ci Time: J3= DD er-4- <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> D CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �— DATE <br /> Electronic Information: ❑ List[I Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street a Street Name city - [] Unit 1 <br /> 2. ❑ Unit U\ <br /> 4110ji Unit 3 <br /> 5. <br /> Unit 4 <br /> B. <br /> © Unit 5 <br /> 10.- _�-•-.---�— <br /> CUnitI <br /> Specifle Date Range of Information Requested: From A_�h_) to _2LL,S<7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHIC%;<� <br /> OTHER CLEANUP SITE(NON-LOP) C I FOOD FACILITY ��AfASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH C3 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED F=u-ry C MOTELIHOTEL C3 PUMPERTRUCKNARDICMEM TOILETS <br /> ❑TATTOO/BODY PIERCING Q POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑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 typg(s)Of files from,the list above by checking the appropriate <br /> box(es). At least One flip type MUST be selected. Fax t4(Z09)464-0136 or mall to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with fie addresses,contact the EHD. Appllcatlons received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any FHA files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> J1 <br /> 51113 48.05 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />