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DATE RECEIVED EHD LUG NUMBER <br /> ccg(';/� D SAN JOAQUIN COUNTY <br /> ! '/ _'� EM11 OntoNMENTAL HEALTH DEPARTRNT <br /> w=.„� 600 East Main Street, Stockton, CA 95202-2708 <br /> °' �' �',, 2008 Telephone: (209) 468-3420 Tax: (209) 464-0138 Web: A­ww.sjgov.org e I <br /> 1=NVIROid'VIFNT HE ALTh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: -:I:-VT- <br /> ADDRESS: I�� 7��� ✓��t� q <br /> PHONE(1): 6I9` J'4�9-7/Yp PHONE(2): � ✓✓9Z FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE EST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3fBUSINESS DAYS <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. l <br /> 2• Z() SU �-I La ❑ Unit <br /> 4 Unit 3 <br /> 5. �o <br /> 6. Uh� Unit4 <br /> --- --- — - ❑ Unit 5 <br /> 8. <br /> - ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT X SOLID WASTE FACILITY/VEHICLE <br /> �e OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> Jot UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH 17-1 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 0 POOL/SPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ 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 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 behold 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 /> EHD USE ONLY <br /> *' If you should need further assistance please contact Diane Martinez e (209)468-3425 directly. Thank You*** <br /> EHD 48-06 9/14/2006 <br />