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5-16-08; 12:34PM; ;2099836960 # 1/ <br /> i <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .�OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s�gov /e 1V ` -'Q <br /> PUBLIC RECORDS RELEASE APPLICATION Mlili{UMMEV, i;EALT <br /> t i I v _ e <br /> 1 APPLICANT: C.71^ BUSINESS/AGENCY: S <br /> ADDRESS: Cl Vt0 Cv✓ s O O <br /> PHONE(1):_CZO�J� —���'(Q PH NE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow ten 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 THREE BUSINESS DAYS <br /> I <br /> ' SIGNATURE OF APPLICANT DATE <br /> Electronic In ❑ List ❑ Map Description: <br /> I <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. VV V�0 W 'C� f �:'I, t1C4 l i !tf ; f'IW,# ❑ Unit 2 r �/ <br /> 3. <br /> 4. X�/ nit 3 <br /> 5. (V\v <br /> i6. n^\�(i Unit 4 <br /> 7. v b <br /> 8 C3Unit 5 <br /> 9. <br /> j10. ❑ Unit 6 <br /> i <br /> i Specific Date Range of Information Requested: From ��(�0 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 10 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> 13 OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> Ey UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> 12 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> p ❑TATTOO/BODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ 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 /> i — <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 f209)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 /> i <br /> be processed the next business day. <br /> 1 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 /> F.HO dp.Ofi 10/79If17 PUBLIC RFCOROS RPI EASF APP FORM <br />