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APR-13-2004 03:32P FROM: —9:4640138 P,2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> FD) -LD\�JIENVIRONMENTAL HEALTH DEPARTMENT u 04 East Weber Avenue, 3id Floor, Stockton, CA 95202-2708 <br /> u L��S Tele hone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/chd <br /> al <br /> i TW <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> EN <br /> 4� BUSINESSIAGENCY: <br /> ADDRESS: p ty <br /> PHONE(1): �`7 ODZ� PHONE(2): FACSIMILE: !g iG Qy Q <br /> TENTATIVE"API OINTMENT DATE: Time: <br /> (Please allow 1P business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEgITE REQUEST-$95.0' E ASH OR CHECK O -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE A <br /> Electronic Information: List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# t Street Name City ❑ Unit 1 <br /> VJFF <br /> 2. t i ii LtST M Li ❑ Unit 2 <br /> 3. oe <br /> 4 Unit 3 <br /> 5. 1, N <br /> 6 Unit 4 \ <br /> 7. <br /> ❑ Unit 5 <br /> r=C7P <br /> 9. rR) SII �, Unit <br /> 10. <br /> Specific Date Range of Informa�tlon Request :F m to ter, 1 9C.l� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> IOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MOMTORING�EMOVAL) E3 DOG KENNEL C3 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOOIBODY PIERCING 0 POOUSPA O LAND USE APPLICATION SITES <br /> ❑MEDICAL WAST@ FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:90PM - 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 filet a MUST be selected. Fax to(209)464-0138 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 conflrmod approximately ten(10) <br /> days aftor recelpt of application. The files will behold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively beingorked on by EHD staff may not be Immediately available for review. A new application may be <br /> submitted when the file Is 4allable. <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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 43-06 9/1312006 <br />