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08 12:25p Paul Humph, 0 <br />(0 226-3408 P'1 <br />EM LOG NUMBER <br />1 i'J D SAN JOAQUIN COUNTY <br />Ef, ENVIRONMENTAL HEALTH DEPARTMENT <br />MAY 1 5 2008 600 East Main Street, Stockton, CA 95202-3029 <br />6?z <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjg v.o <br />FPVIRL?WENT HLALTH <br />P1=R.M1TIS'ERVkCES PUBLIC RECORDS RELEASE APPLICATION <br />VSO) <br />BUSINESSIAGENCY. <br />APPLICANT: <br />ADDRESS: L: <br />FACSIMILE; <br />PHONE (i): <br />-PHONE (2); <br />Time. <br />TENTATIVE- APPOINTMENT DATE: <br />(Please allow ten business days from date of application submittal - "Tentanye only 'must be confirmed} <br />ECK BOX TO EXPEDITE REQUEST - 398.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN THREE BUSINESS DA <br />/// DATE <br />SIGNATURE OF APPLICANT <br />Electronic Information: <br />E 'List ❑ Map - Description: <br />specific date Range of information Requested: From <br />T L� <br />,..nfcuir, c X <br />0 HOUSING ABATEMENT UL�U YYMJ .'., -awe• • •• • ^- (((;;;+++ . <br />15UNDERGROUNDTANK (UST) CLEANUP SITE (LOP) 0 FOOD FACILITY WASTE TIRE , O <br />�THER CI.EANUP SITE (NOM -LOP) 0 DOG KENNEL C DAIRY \1 <br />P"N DERGROU ND TANK (MON ITO RINGIR EMOVA L1 0 CHICKEN RANCH %U WASTEWATER TREATM ENT PLANT <br />2T HAZARDOUS WASTE GENERATOR 0 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br />TIERED PERMMED FACILrTY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />0 TATTOOIBODY PIERCING ❑ OTHER (PLEASE SPECIFY) <br />❑ MEDICAL WASTE FACILITY <br />REASJAILA84EFORREVfEW hdIONOAY-FwDAY8:ObAM—S:UOPw - EXCLUDING HOLIDAYS. <br />WELL AND SEP=PERNITRECORDSA <br />7. 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 209 464-0736 or mail to the above address. Address ranges will <br />not be accepted -for additional assistance with file addresses, contact the @HD. Applications recelved atter 3:00 pm will <br />be processed the next business day. <br />• t t for review will he confirmed approximately ten <br />2. The EHD will notify the applicant if any EHD files exist. An appom men ointments <br />days after receipt of application. The files will be held for a maximum of five business days for review. App <br />should be scheduled accordingly. <br />by the EHD staff may not be Immediately available for review. A new application <br />3. A file that is actively being worked on <br />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 applicant <br />(Future fele reviews by the same applicant may require a $98.0a deposit prior to review. <br />EHD USE ONLY <br />