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n T � <br /> R;MITE© SAN JOAQUIN COUNTY 6 EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP O 3 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone; (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.or /e <br /> ENVIRONMENT HEALTH <br /> PeR,dttT(SERVUS PUBLIC RECORDS RELEASE APPLICA N <br /> APPLICANT: —TW hpn-ey / o• ,BUSINESSIAGENCY; _ <br /> ADDRESS: —902 lndu tl'181 ay . ciry�staramp _ juj CA_95Z40 <br /> PHONE(1): 209-3Fi7-3701 PHONE(2): FACSIMILE: 209-3h&-422.8-_-_ <br /> TENTATIVE*APPOINTMENT DATE: 2^'k- '-0 Time: <br /> (Please allow 10 business days from date Of Application submittal-"Tentative Only•must be confirmed) <br /> HECK BOX TO EXPEDITE REQUEST $106 FEASHOR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ( DATE <br /> Electronic inforrnatlon: <br /> El List[] Map–Descrlptlo <br /> FILEADDRESS EHD USE ONLY r <br /> _ Street# Street Name <br /> fJ unit 1 <br /> 2. C _ _R-4-1A O ❑ Unit2 <br /> I\ a• �v�-C� � c wa -- <br /> V 4 Zlq U � G,l� riT �SfA+fTla(SP UnR3 <br /> 5. <br /> 6 unit4 <br /> 7, <br /> 8. ❑ Units <br /> 9. <br /> 10, FJunits <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK JUST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 13SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SIZE(NON-LOP) 0FOOD FACILITY 13WARTE TIRE (,G)/•+�j. `� <br /> UNDERGROUND TANK(MONITORINOIREMOVAL)rC E3 DOC KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR 13CHICKEN RANCH C3 WASTEWATER TREATMENT PLANT O <br /> TIERED PERMITTED FACILRY M MOTELIHOTEL 171 PUMPER TRUCKIYARD/CHeM TOILETS <br /> 0 TATTOOIBODY PIERCING ❑POOLISPA O LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 173 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-B:OOPM - EXCLUDING HOLIDAYS <br /> 1. List up to ten addresses In the space above. Select the type(a)of fllas from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall 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 EHn 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$106 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-00-8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />