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i EHD LOG NUMBER <br /> � <br /> DATE RECEIVED _ <br /> SAN JOAQUIN COUNTY <br /> ENVWNMENTAL I3EALTH DEPARTMYNT <br /> 600 East Main St. Stockton, CA 95202-270 7 '?5 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web- <br /> PUBLIC <br /> /eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: CA <br /> p BUSSINLESS/AGENCe_ <br /> _Y: ,nA' <br /> ADDRESS: S C[�i FALC�ON! –� �E T t4 // l` — <br /> PHONE(1): S7or6l� PHONE(2): , �FACSIMILE:,516—4 —'2zEL <br /> TENTATIVE*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-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT L-f _DATE 4 Zb <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 ,✓ <br /> 1. X37 S ' ! <br /> 2. ❑ Unit 2 \ <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> 6 <br /> 1�- <br /> 7. k <br /> rEl Unit 5 <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LO ❑ HOUSING ABATEMENT 0 SOLID WASTE F�ACILITYIVEHICLE <br /> THER CLEANUP Sl7 (NON-LOP) 1 ❑ FOOD FACILITY 0 WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑ POOLISPA ❑�L'ArND/J'3SE APPLICATION SIT S, c <br /> ❑MEDICAL WASTE FACILITY MOTHER(PLEASE SPECIFY)' t7 K rf mfr a ( 3 (J!!6E <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA <br /> I/BL <br /> ``E FOR REVIEW - <br /> MONDAY-FRIDAY$:00 AM-5: <br /> OOPM - <br /> 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 bione Martinez (209)468-3425 directly. Thank You*** <br /> EHD 4"6 5!14!2006 <br />