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MAY-31-2008 01 :48 AM P. 1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .IOAQUlN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 Z5 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: E" —rRSU81N1861?EN Y: ^���/ <br /> ADDRESS: V ��� `I, 7T �L <br /> 3 <br /> PHONE(1): Q� 7� PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Tlma: J C)O 4 ill <br /> (Pleats allow tan business days from date(of appll on su mlttel-"rentsUve only-must ba Confirmed) <br /> CHECK BOX TO EXPEDITE R9QUEMOO F E(CASH b C K ON6Y REQUEST PROCESSED IN THREE U31N 9 DAYS <br /> SIGNATURE OF APPLICANT C - DATE �C� <br /> Electronic Information: ❑ List❑ Map-Description: V C7 T <br /> FILE ADDRESS EHD USE ONLY <br /> Street iF street Name CityO Unit 1 <br /> r I <br /> Io ^ ❑unitz <br /> 4.2 <br /> � UnitB Unit <br /> 7. <br /> g Unit 6 <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUNO TANK(UST)CLEANUP SITE(LOP) '> ING ABATEMENT 0 SOLID WAm FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑FObo FACILITY 0 WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOvAI) ,13�po(3 KENNEL ❑DAIRY <br /> AZARDOUS WARTS GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> f7 TATTOUDODY PIERCING 0 POOL1SPA k LAND Sp APPLICATION 6(TEP <br /> 13 MEDICAL WASTE FACILITY �THER(PLEASE SPECIP1Y) 1)11 rnct l Lkl� U 2 q � i ��C hal'o", <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE MOR R5VtEW - MONDAY•FRIDAY 8,00 AM.5100PM • ExcLUD 0 HOLIDA <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(sa). At least one file type MUST be selected. Fax to(209)464.013§oC Mall Ig the pAQyg agam g, 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 /> 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 EHD staff may not be immediately available for review. A new application <br /> may be submitted when the file is avallable, <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 /> F96ZRO 101W07 PUBLIC RKGO"RKLaASK APP FORM <br />