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03/11/2008 10:12 91686104 <br /> WE <br /> SECOR PAGE 02/02 <br /> 1"l U SAN JOAQUIN COUNTY i HO OG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAP 11 200$ 600 East Main Street, Stockton,CA 9112-1111029 2 /// <br /> Telephone: (209)468-3420 Fax: (209)464.0138 Web:www.sjgov.or8/ <br /> u3ENVIRONMENT HEALTH <br /> PERtvMIT/S RVICES PUBLIC <br /> AARECORDS RELEASE APPLICATION <br /> APPLICANT: ����.y/�/fo <br /> G BUSINE33/AGENCY:_SS-/�"'�. /KT <br /> ADDRESS: <br /> q // ,,��``,,��11,, <br /> PHONE(1):/��—�IOI'/./77A/ PHONE�.7Ifi�""r��0 OY�� FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: r% nma: /O %� <br /> (Plsaaa allow 10 busineas days from tlats o RPPllcatlon Submittal•"rantotive only-must ba Dorlf(mtad) <br /> CHECK BOX TO EXPEDITE RE UEST-39 00 FE SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 8 SI SS DAYS <br /> SIGNATURE OF APPLICAN'�i'"7L � DATE (I/ <br /> 1 <br /> Electronic information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> _Streot# Street Name Qlty ... <br /> [I r n Unit 1 <br /> 2. Z <br /> 3. 0— S _ _ T. �. r'.❑ UnR2 <br /> 4. ..,- Unit (I <br /> S. <br /> S• .,, Unit 4 �l <br /> 7. l <br /> 8. ❑ unes <br /> T0. ❑ unit <br /> Specific Date Range of Information Requested:From to '1h <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IUNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOusING ABATEN2NT ❑SDub WASTE FpOILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) O FOODFACILITY 0 YVAzM TIRE <br /> UNDERGROUND TANK(MONTIORINOMEMOVAL) ❑DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH Cl WASTEWATER TREATMENT PLANT <br /> TUIRED0/13Qo PIERCIED NG <br /> FACILITY ❑MOTELIHOTEL CI PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOO/aCDY pIERCINO ❑POOLISPA O LAND USE APPLICATION SITS <br /> ❑MEDICAL WASTE FACILITY C3 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-PRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax-. (2091464.0138 or mail to the address indicated abo Address <br /> ranges well not be accepted-for Additional assistance With flee addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHDwill notify the applicant if any EHD flies 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 E'HD staff may not be immediately available for review. A now 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 ENP staff At the expense of the applicant. <br /> Future file reviews by the some applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> e"O"44WER 010=7 <br />