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_. ,-,_,,_-_,•_•((-�� Mn CHU LVV NUMBLK <br /> AQUIN <br /> RECE� v E COUNTY <br /> ENVI JNMENTSAN JOAL HEALTH DE ARTM�.T <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> 2005 <br /> DEC 1 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehdZ <br /> Ell""NiENT�HEEs N PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAG�EN�CoY: <br /> ADDRESS: FV9 CITY S L C9 cwt STATE R--�� <br /> PHONE(1): PHONE(2): ^7 FACSIMILE: <br /> r , <br /> TENTATIVE"APPOINTMENT DATE: _c� `Q Ste-- 0 L 2 Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> No DC ECK BOX TO EXPEDITE REQ $93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> J'SIGNATURE OF APPLICANT 47h/71DATE <br /> Electronic <br /> N,`, Information O List OMap-Description <br /> FILE ADDRESS EHD USE ONLY <br /> Street If Street Name City <br /> 1' ❑ Unit 1 S <br /> 2. L� <br /> 3. ElUnit 2 <br /> 6• ffl Jnit 3 <br /> 6. <br /> 7. /Unit 4 <br /> 8. <br /> 9• ❑ Unit 5 <br /> 10. 1 ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 0 TATTOOIBODY PIERCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 0 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 ten addresses in the space above. Select the type(s) of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges Will not be accepted—for additional assistance with file addresses, contact <br /> the EHD. Applications received after 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 <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> I _ <br /> END 4L-06 <br /> tOp112006 <br />