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DA EHD LOG NUMBER <br /> y SAN JOAQUIN COUNTY <br /> Lrti!- <br /> ENVIRONMENTAL HEALTH DEPARTMENT A <br /> SEP 0 6 2007 600 East Main Street, Stockton, CA 95202 J^J <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www. rg t <br /> ENVIR01N%1ENT MERE?FI <br /> QrRf,AT/SERVjC-:S PUBLIC RECORDS RELEASE APPLIC ION <br /> APPLICANT: DA✓-7—b BUSINESS/AGENCY:'i'/'0E 'Cc c oyZ0 <br /> ADDRESS: '15-30 E RKE.T 3T SToc(GTD/�I G,4 'ICLOJ / <br /> PHONE(1):62 nal 4-2 T: 'o PHONE(2): FACSIMILE[\\\?Aj) 57 — $�8� <br /> TENTATIVE`APPOINTMENT DATE-.-7—;6r>DATE-.-7—;6r> Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE RQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / ��— DATE <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> FILE ADDRESS EHD USE ONL _ _ <br /> Street# Street Name City Unit 1 <br /> 1. uti f f" i.ILtA ti d-- I <br /> Unit 2 <br /> 2. <br /> 3. <br /> ❑ Unit 3 (\� <br /> 4. 1 \ <br /> 5' tl} Unit4 <br /> 6. \ <br /> 7. - <br /> 1 p ❑ Unit 5 <br /> 8. QA AC <br /> 9. ❑ 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) ❑ F/OUSING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE <br /> •OTHER CLEANUP SITE(NON-LOP) WOOD FACILITY WASTE TIRE <br /> 13 UNDERGROUND TANK(MONITORING/REMOVAL) C3 DOG KENNEL El DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> Cl TIERED PERMITTED FACILITY ElMOTELIHOTEL 13 PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING O POOL/SPA CI LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM - 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 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 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EH1349406 9/512001 <br />