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APr, 23. 2008 11:03AM 1 1 need Geo[nvi ronmental No. 1830EHDP.__ 1UMeER <br />DATE \ SAN JOAQUIN COUNTY <br />III\\�IjI�IrJJ <br />,` j `�, _ - ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street; Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fair: (209) 464-0138 Web: www.sjgov.org/ehd <br />1 N <br />APPLICANT' <br />ADDRESS: � _ 7 <br />PUBLIC RECORDS RELEASE APPLICATION <br />A YrC,vt u "z CS <br />BUSINESSIAGENCY: va'"Oed 6rC <br />PHONE (1): / I lGiPHONE (2)' l Ci FACSIMILE: <br />TENTATIVE` APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal-"rentativo only - must be confirmed) <br />OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAY <br />DATE ' Z3 _U <br />HECK BOX TO EXPEDITE REQUE - $98.00 F <br />SIGNATURE OF APPLICANT <br />Electronic Information: ❑ List ❑ Map - Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />'9 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT mrgour, wAsTE FACILITYtVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br />1"NDERG9OUNo TANK (MONITORINal REMOVAL) © DOG KENNEL ❑ DAIRY <br />4kTIA7AR0009 WASTE GENERATOR 0 CHICKEN RANCH 11 WASTEWATER TREATMENT PLANT <br />11 TIERED PERMITTED FACILITY C] MOTEL/HOTEL 71 PUMPER TRUCK%YARDICHEM TOILETS <br />171 TATTOOIBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITE$ <br />C3 MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONoAY-FRIDAY 8:00 AM-8:00PM - EXCLUDING HOLIDAYS. <br />1. List up to ten addresses in the space above. Select the type(&) of flies from the list above by checking the appropriate <br />box($$)• At least one file type 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 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 $98.00 deposit prior to review. <br />r -HD USE ONLY <br />EHD 48-06 WEB eWO07 <br />�1 <br />0 <br />