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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENvr� ONMENTAL HEALTx DEPART 'NT <br /> 600 East Main St. Stockton, CA 95202-270 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.s� /eh/ %7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: AcT <br /> n BUSINESS/AGENCY:Tf'y1' (j,-C <br /> ADDRESS: 2. <br /> ? 4I I;h C49)N-Q.>& r F.9.6&&wr <f�dC-)q5 -6 ��--// <br /> PHONEE(1): JI��bJQ� f'M' PHONE(2): ` FACSIMILE:ytd`-�f —ZC8 <br /> ceJTENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE 081 Ze) 6 <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> {� FILE ADDRESS EHD USE ONLY <br /> r Street# Street Name Cit I I C <br /> y (:5 1) 1 �1( <br /> (.V G f ❑ Unit 1 <br /> ❑ Unit 2 <br /> 3. <br /> 4. Lflt3. <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. <br /> r. " �- ' ❑ unit 5 <br /> 8. _ fe <br /> _001-011111 1 <br /> 9. <br /> 10. _ > El Unit 6 <br /> 10. 7 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT 13 SOLID WASTE FACILITY/VEHICLE <br /> THER CLEANUP SITE(NON-LOP) °� ❑ FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) 171DOG KENNEL 13DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOUSPA �� 13LAND USE APPLICATIONS S,,^7 <br /> ❑MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)i x�_F-UR 1 I&P, /E}'c-n6N RUI/Cf- <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 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 EHD files 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 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHD 48-06 9/14/2006 <br />