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DATr4EEC�, V h D ROSAN JOAQUIN COUNTY • jo EHD LOG NUMBER <br /> UUV E iNMENTAL HEALTH DEPARTMENT <br /> bc.u 0 7 2006 304 East Weber Avenue, 3Td Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENT HEALTH <br /> PER(OIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Pal( <br /> BUSINESSIAGENCY: <br /> ADDRESS: Z. Pa IC P/,lza 5v2y;+c. Z4-o T(vr'ne � (1-A9Z6/y <br /> PHONE(1): 449" 757- )2Z7 1�4�' PHONE(2): FACSIMILE: 9y -7_s_7- 1797 <br /> TENTATIVE*APPOINTMENT DATE: k- Ir Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be c <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED fit <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 1• 11 Vo e_ e-- Paid LOCEe.(o( U� <br /> 2 Ef Unit \� <br /> 3. <br /> 4 Unit 3 0. <br /> 5. rrII <br /> 6. I D - Unit4 <br /> 7. <br /> ❑ unit 5 <br /> 8. ng 18 2006 <br /> 9. *A Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIL <br /> DERGROUND TANK(UST)CLEANUP SITE.(LOP) 10 HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> 56THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> I�'���N RGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL 13 DAIRY <br /> "' US WASTE GENERATOR 13 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> ERMITTED FACILITY ❑MOTELIHOTEL - 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> E3 TATTOOIBODY PIERCING 13 POOLISPA 13 LAND USE APPLICATION SITES V' <br /> ❑MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to len 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 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 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 applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4"6 SIM006 <br />