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ei i,s 2bby 15:44 4088650122 <br /> 4ATERECcoveD • PAGE 01/01 <br /> SAN JOAQUIN COUNTY EH°LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, 38 Web: ww. !�c/r��i dd <br /> ,�r;iti � 2009 Telephone: (209)468-3420 Fax; (209) 464-0138 Web: www.sjyDJ� l — <br /> E NC'r. IIViINT HEALTH <br /> E PUBLIC RECORDS RELEASE APPLICATION <br /> Dsl�l ff^ <br /> BUSINESSlAOENCY: <br /> ADDRESS: CI IStatelzl <br /> ( ) h P Cl 77 TO � A <br /> PHONE(1); �_ <br /> PHONE(Y): <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: <br /> (PlOase allow 10 business days from date Of aTime; <br /> ppiication submittal-'Tentative only-must be cOnfirmPd) �" <br /> CHECK BOX TO EXPEDITE REQUEST.$105 l.F�(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 9 USiNE88 DAYS <br /> SIGNATURE OF APPLICANT gV�16lIN✓ DATE 1, 13 a <br /> Electronic Informatlon: ❑ LFst(]Map—Description: <br /> FILE ADDRESS EHD US <br /> Street Ir Sheat Name city -- wEONLY <br /> 2 Q� <br /> 35 <br /> [] Unit 1 <br /> 3. C❑ Unit 2 <br /> 4, <br /> 5- UnR 3 0 <br /> Ile <br /> 8 UnIt i �\ <br /> 7. <br /> 0 ❑ Unit s <br /> 9. <br /> 10. 11 unit 6 <br /> Specific Date flange of Information Requested:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ITA <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT <br /> TXER CLEANUP SITE(NON-LOP) ❑rOOa FACILITY Q SOLID WASTE FACIOTYIVEHICLE <br /> NOERGROUND TANK MONIT WASTE TIRE <br /> ( ORINGIREMOVAL) E3 DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR O MOTELIN RANCH ❑WASTEWATER TREATMENT PLANT <br /> EREOPERMITTED FACIUTY MOTELINOTEL WASTEWATER <br /> TRUCK(YARDICXEM TOILETS <br /> meOB0xBr FRCINO ❑POOLISPA LAND USERUCKIYAPPLIcATD)N SITES <br /> EDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT HECORDS ARE AVAILAE.LE FOR REVIEW- MONDAY-FRIDAY e:O'AM-6:OpPM -EFGLUDING HOLIDAYS. <br /> 1. List up to fen addresses in the space abova. Selecf the types)of nfas from the list above by checkitlg the appropriate <br /> box(es). At least one Tile type MUST be selected. Fax to(Z S)484-0198 Or mail to the address indicated bove Address <br /> ranges will not br accepted—for additional assistance wrth gle addresses,contact th¢EHD. Applications received <br /> after <br /> 8:00 pm will be processed the next W$ine0 <br /> 8 day. <br /> 2. The EkD w111 notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days atter recelpfofappllcation. Th¢files will be held for a maximum of five business days for review, Appolntm¢nts <br /> should be scheduled accordingly. <br /> 3. A file that Is aCUVegI being worked on by EHO staff may not be Immediately avaflabie for review, A new application may be <br /> submitted when the file IS available. <br /> 4. Any fife 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$tu5 deposit prior to review. <br /> EHD USE ONLY <br /> EHD�d-O6 a104/08 <br /> PUBLIC RECORDS RELEASE APP FORM <br /> J <br />