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05/14/2008 13:11 FAX 213 680 6499 BINGHAM MCCUTCHEN 2 fI001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 'e <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgo3151dC) <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT;-7 BUSINESS/AGENCY: <br /> ADDRESS: -3S5 V ' 1 <br /> PHONE(1); � —�� jfJ�j� PHONE(2): FACS(MILE: 2 ) <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-t9 10101 FEE CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map - Description, <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1 <br /> )/--Cherok - <br /> 2. 2, --.. J--�" •..� �7 ❑Unit <br /> 3. 77 <br /> 4. <br /> —— _-- nit 4 <br /> 7. <br /> O Unit 5 <br /> 13 <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTHEPARTMENTyF�.IILES <br /> NOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT A�tiOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 'XWASTE TIRE <br /> NDERGROUN0 TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZA ROODS WASTE GENERATOR 11 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> C3 TIERED <br /> PERMITTED FACILITY ❑ MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> C]TATYOO/Bony PIERCING ❑POOLISPA O LAND USE APPLICATION SITES <br /> I]MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA9LE FOR REVIEW - MONDAY•FRIOAY 8:00 AM-6:00Pm - 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 rile addresses,Contact the EHD. Applications received after 3:00 pm will <br /> be processed the next business day. <br /> Z. 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 END 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 /> FHD USE ONLY <br /> EHD as-0s ioi2vo� <br /> PUBLIC RECO ROS RELEASE APP Ef1RM <br />