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08/15/2007 15: 04 13107982841 PAGE 01 <br /> EHD LAG NUMBER <br /> Mri <br /> SAN JOAQUIN COUNTY <br /> )ENVIRONMENTAL,HEALTH DEP.ARTME <br /> 5 2007 600 East Main Street, Stockton, CA 95202-302 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov <br /> ENVIKNMENT HEATH <br /> PF IIT/SFRVICES PUBLIC RECO"S RELEASE A.PPLICATI:ON <br /> APPLICANT; a4 +7!)!1 �- t/��V>� BUSINESSIAGENCY, <br /> ADDRESS. C" <br /> '��L-15 <br /> S7d C7 Ca vul`�n t� �e I C . 1�,j�►! rlr � .,4 <br /> y <br /> PHONE(1): -! [- � t 7c PHONE(2): FACSIMILE: 17 lr/y16� -J <br /> TENTATIVE*APPOINTMENT DATE: Time- <br /> (Please allow 10 business days from date of application submittal-*Tentatfve only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUE T-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATEX. <br /> � — <br /> n ' Electronic Information: ❑ List❑ Map—Description: <br /> I J FILE ADDRESS EHD USE ONLY <br /> Street Name CltylG' (SZ U�c (2) ❑ Unit 1 <br /> F <br /> ❑ Unit 2 <br /> r `Q� 3. <br /> 4. Ue�lt 3' <br /> b. Unit A <br /> 7. <br /> 8. ❑ Unit 5 <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From A to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT S01-10 WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONMORINO/REMOVAL) A DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TINRL D PERMITTEP FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCMdYARDICHEM T011-ET$ <br /> 17 TATTOO/BODY PIERCING ❑POOLISPA O LAND USE APPLICATION SITES <br /> L7 MEDICAL WASTE FACILITY D OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM�6.00PM - EXCLUDING HOLIDAYS. <br /> I. 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. Eax to(209)464.0138 9r mail to the address indicated aba_v_e. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will 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(10) <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 FHD 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 some applicant may require a$96.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHp q»�g Wt:s 818!20!)7 <br />