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07/24/2007 11:49 530887 ^95 BLACKBURN PAGE 01/01 <br /> Lr J {RE I I� i�} EHD LOG NUMBER <br /> ' L_3 _ SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> „f 1- , 4 2007 600 E.Mains Strcet, Stockton,CA 95202-3029 <br /> L_I <br /> -11 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjg0V /c <br /> 4 <br /> L,•�a,l+.�r�,.:t.�d{ its.{-, f <br /> F"'!"'` PUBLIC RECORDS RELEASE ,APPLICATION <br /> APPLICANT: Af BUSINESS/AGENCY: <br /> ADDRESS: <br /> PHONE(1). <br /> TENTATIVE"APPOINTMENT DATE ��R.i Time: " <br /> (Please allow 10 business days from date o appllc t J sub�llt "Tentative only-mustconfirmed)-' D <br /> CHECK BOX TO EXPEDITE REQUEST-$96.0 E OR ErLY)-REQUESQ IN 31 S <br /> SIGNATURE OF APPLICANT E <br /> Electronic information: ❑ List❑Ma Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street tF Street Name Ity �t 5��6.}�.... (.l1 <br /> ❑ Unit 1 <br /> 2. El Unit 2 <br /> —4. UnIt3 <br /> Unit 4 <br /> 7- <br /> 8. unit 5 <br /> 9. <br /> ❑ units <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �Ij NDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATFMENT ❑SOLID WASTE FACILITYNEHICLE <br /> �ER CLEANUP SITE(NON^I,OP) ❑FOOD FACILITY ❑WASTE TIRE <br /> f J ORGROUND TANK(MONITORINnIREMOVAL) 0 DOG KENNEL ©DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATToolSoDY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITE$ <br /> CI 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 types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(.20914644138 Or mall to the address indicated_above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHb.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHb flies 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 same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EMWeo-08 U11ar4u 6 WEB <br />