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Apr 11 06 11:45a Clayton 20° r'31-9437 p.1 <br /> VH I t KtVtIVtU T EHD lGG N;1fABPR <br /> SAIL JOAQUIN COUNTY <br /> F (fa 2` �,.'� �; �JJ ENVIRONMENTAL HEALTH DEPARTMENT' <br /> ❑������1 ��l �`, 304 East Weber Avenue, 3rd Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sigov.org/ehd 230 <br /> T I„.,,i"TPUBLIC RECORDS RELEASE APPLICATION <br /> APPLIC/ BUSINESSIAGENCY:r 6 ?c1 < ” <br /> ADDRESS: ro Cb C -( U c 1-t C CITY_ C6t STATE_ 5 S E <br /> PHONE(1)7cf1�I ILO y \�+) PHONE(2): � (��� C13/ /O% FACSIMILE: ?) 23 f_ 9 y 37 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Teritative only-must be confirmed) <br /> 1] CHECK BOX TO EXPEDITE REQUEST-$93 FEE(CASH OR CH CK ONLY)-REQUEST PROCESSED IN 3 BU INE S DAYS <br /> SIGNATURE OF APPLICANT T DATE 1,7 b <br /> Electronic ❑ List ❑ Map aP-Description <br /> FILE ADDRESS EHD USE ONLY <br /> Street if Street Name city <br /> 1' 7 e P�� <br /> 2. ❑ Unit 1 <br /> 3. C- A- f ❑ Unit 24. <br /> 5- ew a j ❑ lnifi 3 <br /> s. <br /> 7. I Unit 4 <br /> a. <br /> 9. ❑ Unit 5 <br /> 10. - unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLA WASTE FACILrrYWENICLE <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> O UNDERGROUNDTANK(MoNrroRINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH jI<WASTFWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑ PUMPERTRUCKNARD/CHEMICALTOiLETs <br /> ❑ TATTOOIBODY PIERCING ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERM RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUCING HOLIDAYS. <br /> 1. List up to ten addresses in.the space above. Select the type(s)of files from the list above by checidr,g the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses, contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. Ttle EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five busine.-s <br /> days for review. Appointments 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 nBw <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> . n <br /> .0 <br /> •ti <br /> EHD Id"96 <br /> t01J1f2006 <br />