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06/03/2008 09:51 FAX 530243165 CH211 HILL • 0002/002 <br />' EHD LOG NUMBER <br />DATE RECEIVED SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT -70 <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.o /e <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: U4n al (q�� BUSINESS/AGENCY: C f Ii <br />ADDRESS: _Z!626 krqw <br />PHONE (1): ":' "�'Z'I' ' ` `, PHONE (2): FACSIMILE:-:'"�39-3�W 3 <br />TENTATIVE" APPOINTMENT DATE: bb �LV6 Time. 120V <br />(Please allow tan business days from date of application submittal - •7entat/ve only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE= REQUEST - $86.00`F15 (CASH OR CHECK ONLY) - REQUEST PROCESSED IN THREE BUSINESS DAYS <br />SIGNATURE OF APPLICANT IWIV DATE CjIfC8 <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS EHD USE ONLY <br />5tre4A9 Street Name City ❑ Unit 1 <br />2• <br />3K3�, <br />Unit 2 <br />Unita <br />6.- <br />7. <br />S- El Doc a.dC' <br />Qi c�B a�.y <br />Unitd <br />..3t.._5 <br />t Amr a do <br />❑ Unit <br />ff e"P cam. 54 <br />10. <br />�b ( <br />fat �, r�v� <br />F <br />nit 6 <br />Specific pate Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />,,,,(UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br />�THER CLEANUP SITE (NON -LOP) C] FOOD FACILITY WASTE TIRE <br />AJNDERGROUND TANK (MONITORING/REMOVAL) O DOG KENNEL ❑ DAIRY <br />L°( HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRIJCKIYARDIC14EM TOILETS <br />❑ TATTOO/BODY PIERCING 71POOUSPA LAND USE APPLICATION SITES <br />171u MEDICAL WASTE FACILITY OTHER (PLEASE SPECIFY) Nt,4 1Aci' , w0 A S � -C. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY -FRIDAY 8:00 AM-S:OOPM - 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 (2091464-0138 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 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 available. <br />4. Any file not returned in the some 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 />END 40-06 10129107 PUBLIC RECORDS RELEASE APP FORM <br />