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09/26/2008 14:49 FAX 559 44" r,081 RLEINFELDER <br />W. (8 � 1 <br />SAES JOAQUIN COUNTY <br />SEP 2 6 2008 tNVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />ENVIRONMENT HEAL'Klephone: (209) 468-3420 Fax: (209) 464-0138 Web: v,(ww.sjgov.org/ehd <br />Pf-R ITISERVICE-S <br />PUBLIC (RECORDS RELEASE APPLICATION l <br />APPLICANT:; -''I �.{ (;L:1^ 1 . (; i/''_�i t.� BUSINESS/AGENCY: <br />ADDRESS: <br />PHONE (1): � KSCr'tw �' t_1 PHONE (2):65-7"), Ct: y 7 /7.5 % FACSIMILE: <br />t7" nl <br />TENTATIVE* APPOINTMENT DATE?,, Time: <br />(Please allow ten business days from date of application submittal -'Tentative only - must be confirmed) <br />❑ ` <br />CHECK BOX TO EXPEDITE REQUEST - $98.00'FEI� (CASH OR CHECK ONLY) - REQUEST PROCESSED IN THREE BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />2002/002 <br />EHD LOG NUMBER <br />Electronic Information: L,I List ❑ Map - Description: <br />FILE ADDRESS <br />Street -#1 Street Name <br />3. I .�; �•..F I <br />fie <br />10. <br />END USE ONLY <br />City -- <br />ci Unit 1 <br />S NO <br />/ No I NQ co;p', <br />C Unit 2 <br />- b yogi A)f F <br />Uriit3G' <br />-` U t5, r, Cr, tiled sT �it4 <br />nit 5 <br />O Unit 6 <br />Specific Date Range of Information Requested: From �.1, -,fig �. �'�.�{r\L <br />to <br />�� <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />••�-r UuNDERGROUND TANK (UST) CLEANUP SITE (LOP) fHOUSING ABATEMENT 11 SOLID WASTE FACILITYNEHICLE 2 <br />THER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY ❑ WASTE TIRE �{ / lO <br />HUNDERGROUND TANK (MONITORING/REMOVAL) pc 11 DOG KENNEL D DAIRY <br />AZARDOUS WASTE GENERATOR D CHICKEN RANCH O WASTEWATER TREATMENT PLANT 1/ <br />TIERED PERMITTED FACILITY!} ❑ MOTEL/HOTEL PUMPER TRUCKNARD/CHEM TOILETS <br />13 TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />O 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. 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 file addresses, contact the EHD. Applications received after 3:00 pm will <br />be processed the next business day. <br />2. The END 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 />Fun r rce nen v <br />