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06/03/2008 09:51 FAX 53024316 ' _ C112H HILL X002%002 <br /> DATE RECEIVED END LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT -7C <br /> 600 Last Main Street, Stockton, CA 95202-3029 , <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.o /e <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I BUSINESSIAGENCY: CH7-►1 of I <br /> ADDRESS: _'LZ Z <br /> PHONE(1): `' 3 "�'�'I' �` '� PHONE(Z): <br /> FACSIMILE: S''"339 <br /> TENTATIVE"APPOINTMENT DATE: Time: l;P <br /> (Please allow tan business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$96-00 FE (CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 'S. DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City I ❑Unit 1 <br /> 1 30 ,5. �1 Oornc�o � &t,_f�.}.ann� . M, 0� <br /> 32 Ll-2 S. rte.4.0 /10 10 WV!t�' I(( <br /> It N <br /> it 3 'n <br /> V` �1 S. El Dycatlp to <br /> _I� I'26 s Qi Q a1) r(/b �p N�j��L� . t1W�bl) �LSS 60 UJnit4 <br /> Unit <br /> 54 <br /> "VVaA-1- no nit 6 <br /> Specific Date Range of Information Requested:From _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES `p <br /> ,,(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHIC E <br /> u OTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY MKWASTETIRE <br /> /UNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL ❑DAIRY �^ <br /> Ej/�-{'AZARDOUS WASTE GENERATOR L1 CHICKEN RANCH M WASTEWATER TREATMENT PLAN <br /> W,I)ERED PERMITTED FACILITY 13MOTEL/HOTEL 0 PUMPER TRUCK/YARDICHEM TOILE <br /> •TATTOO/BODY PIERCING ❑POOUSPA .'11 LAND USE APPLICATION SITES <br /> •MEDICAL WASTE FACILITY WOTHER(PLEASE SPECIFY) 0.t� IA i''2, <br /> WELL AND SEPTIC PERMIT REGORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAF 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 above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> be processed the next business day. <br /> 2. The EHD will notity the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten <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 the EHD staff may not be immediately available for review. A new application <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 file reviews by the same applicant may require a S98.00 deposit prior to review. <br /> t EHD USE ONLY <br /> E14[)40-06 10120/07 PUBLIC RECORDS RELEASE APP FORM <br />