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SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 2007 600 East Main Street, Stockton, CA 95202-3029 <br /> Yelephone.• (209)468-3420 Fax: (209)464-0139 Web; www.sjgov.org/ehd <br /> IN <br /> 3079 <br /> 11-RVICIES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: Ailf. <br /> - <br /> ADDRESS: 041+11j I/t-A IA-6 Its 141a bV4.4- ill-e4le-- elq- <br /> PHONE(l): PHONE(2): FACSIMILE- <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of a pplicatlon submittal-*Terytative only.must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-S98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: El List F]Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroat Street Name City <br /> Unit I <br /> D Unit 2 <br /> Unit I <br /> ONLY <br /> 2 <br /> it 4. 4n <br /> n3 <br /> % It dO <br /> 6. Unit 4 <br /> 7. <br /> unit 5 <br /> 9. <br /> 10. -------- ❑ unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -9�r ERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE <br /> ;6-MER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY M WASTE TIRE <br /> LMIOERGROUND TANK(MONITC)RING/REMOVAL) 13 Doa KENNEL <br /> n6HAZARDOUS WASTE GENERATOR M DAIRY <br /> C3 TIERED PERMITTED FACILITY in CHICKEN RANCH M WASTEWATER TREATMENT PLANT <br /> *TATToo/BoDy PIERCING 13 MOTEL/HOTEL n PUMPER TRUCK/YARD/CHEM TOILETS <br /> * MEDICAL WASTE FACILITY 13 POOLISPA 13 LAND USE APPLICATION SITES <br /> M OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT R2corws ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY U.00 AM-5:00pm - 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 (200)464-0138 or mail to the address indlcall!tabove. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHO.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,hold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked an 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 OPPIlCant May require a$98.on deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4"6 WEB 811314uu7 <br /> TO 3E)Vd TV8Z86t016T L9 69 L09Z/9Z/68 <br />