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Rug 15 2008 2: 39PM 925 "-3-2109 p. l <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)488-3420 Fax: (209)464-0138 Web: www.sjgov.o /e <br /> R V4 <br /> PUBLIC RECORDS RELEASE APPLICATI /�N�Y,, <br /> APPLICANT: i5ri.o � S BUSINESSIA,G{ENCrY: i�'A%T1. <br /> ADDRESS: 1 t C t' �1.. Cltylstabeizip I�'r17 Ltt eJ, �A t� <br /> PHONE(il: ( PHONE(2): FACSIMILE: LZ.ti •�7 <br /> 53•20!j- <br /> TENTATIVE'APPOINTMENT DATE: 1C , z- '_7Q Time: <br /> (Please allow 10 business days from date of application submittal-•Tentadve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-5705 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT >�� DATE �• �' OZ <br /> Electronic Information: ❑ List❑Map-Description: APr4 'S Z 6' .3-007 J6� 3• DO <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> [7Unit 1 <br /> s W 1 <br /> 2• - ❑ Unit 2 <br /> 3. _ <br /> 4, - unit 3 <br /> -6 Unit 4 <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 8. <br /> - -- - -- -- ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From I!j 7 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) O HOUSING ABATENE_NT ❑SOLID WASTE FACiurrY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY Cl WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIRemovAL) 0 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERUTTED FACILITY 0 MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 0 POOLfSPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACIUTY 17 OTHER(PLEASE SPECIFY) <br /> WELL ANDSEPTIC PERMITRECORDS ARE AVAILABLE FOR REVIEW- NONDAYfWOAY 8:00AM-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 appropriate <br /> box(es). Al least one file type MUST be selected, Faxtof209)464.0138 or mail to the 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 END files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies will be held for a maxi num 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 file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-De 8104!08 PUBLIC RECORDS RELEASE APP FORM <br />