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7"RECE9E <br /> D SAN JOAQUIN COUNTY - tHU LUV NUMBER <br /> ENVIr:,,�,tVMENTAL HEALTH DEPARTME4x, <br /> JUL 2 5 2006 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd ° v <br /> ENVIRONMENT I�EALTH n <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i 12� BUSINESS/AGENCY: fLELC /� /✓j�/ <br /> ADDRESS: CITY TATE <br /> PHONE(1): PHONE(2): FACSIMILE: I'T 7—a 3 2__ <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQ 7, <br /> T-$93.00 FE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic ❑ List ❑ Map Description <br /> Information - <br /> FILE ADDRESS <br /> Street# Street Name city EHD USE ONLY <br /> 1. <br /> 2. _ ❑ Unit 13. <br /> . <br /> 4 1:1 Unit 2 <br /> 4. <br /> 5. ❑ Unit.3 <br /> 6. <br /> 7. Uni <br /> 8. <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) 13HOUSING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE <br /> i5'dC OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL 13 DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH D WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 13 MOTEUHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTI: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 type(s)of files from the list above by checking 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. The 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 business <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 new <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 /> fl <br /> I <br /> EHD 48.06 <br /> 10/31/2006 <br />