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!J' <br /> 11/20/2007 11:08 415-398 ","67 -BANK OF THE WEST PAGE 01/01 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> RW E� �VED ENVIRONMENTAL HEAI TkI DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-302 <br /> NOV 2 0 2007 Telephone: (209)468-3420 Fax: (209)464-0138 Web;www.sjgov.org/ehd vI&" <br /> ENIMOUMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION R D— <br /> APPLIdkNT?' vGC hE✓' r BUSINESS/AGENCY:_�i V d r1 72t-8 W'C,�-f' <br /> ADDRESS: I KO t-11OA'f g Y WL let NPHONE(1): IIS'-?99— kzo7 PHONE(2):-y/.S'-30r^0/q9 FACSIMILE: y/q 39ff' -M7 <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal�'Tentative only-must be confirmed) <br /> ❑ CHECK SOX TO EXPEDITE REQUEST-$98.000 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT C J i_ DATE /1-00-07 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N - Street Name City ❑ Unit 1 <br /> 1 7�J0 T rrN�n v 1� ��ovkftl v <br /> 2. ❑-'unit 2 <br /> 3. <br /> 4 Unit 3 <br /> I' <br /> 9. ❑ Unite <br /> 10, <br /> Specific Date Range of Information Requested:From ^✓ - S'3 to A/ �G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> %P(UNOERGROUNO TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY 0 Momt-MOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOO/BOoY PIERCING ❑POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILRY OTHER(PLEASE SPECIFY) <br /> WELLANDSEPTIC PERMIT RECOROSAREAVAILAOLE FOR REVIEW-MONDAY-FRIDAYS:00 AMS:00rm - EXCLUDING HOLMAYs, <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(2091464-0138 or mail to fhe address indicated above 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 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 rile reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHDA840WEB 607W7 <br />