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07/07/2008 11:56 FAX 559 256 1478 URS FRESNO 001 <br /> 0 is <br /> DATE RECEIVED ( <br /> SAN JOAQUIN COUNTY END LOG NUMBER <br /> �� •�� (1��1' ';! <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> t 20G 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.o03r <br /> ,�•lig•-;•!�'��'1C1�' ��R� ` <br /> ES PUBLIC RECORDS RELEASE APPLICATION <br /> APP LICANT.• tt, <br /> -- ��� BUSINESS/AGENCY: IJI,Q,S <br /> ADDRESS: I IL • v 190 494NO zo <br /> PHONE(t): -- 2 _ PHONE(2): FACSIMILE: :Mf-;�_ & N7.6 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow ten business days from date of application submittal-*Tentative only-must be confirmed) <br /> 17 CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE '7/-7100 <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. OC v = z� fit? S'4'oL " ot4 04 (m y6"' W <br /> 2. ❑Unit 2 <br /> 3. <br /> 4. <br /> 5. x� \ <br /> 6. <br /> nit 4 <br /> 7. <br /> 8' O Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested:From t.X_ to i <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES fj`p e 1 five- <br /> 13 <br /> TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILnYNEHICLE ��Y��J1lM�i •"�'pr <br /> ❑�FHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE 2 4NI J <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY I J <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> O 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 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(209)464-0138 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> ' 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 <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 the EHD staff may not be immediately available for review. A new application <br /> 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 applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> I <br /> EMD 48A8 70129107 PUBLIC RECORDS RELEASE APP FORM <br />