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AUG-26-2009 11:48 From: To: 12894640138 PaQe:1/1 <br /> � . s <br /> DATE RECEIVED EI•ID LOG NUMBER <br /> SAN ,IUA(�UIN COUNTY <br /> W1fM%n ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: \ BUSINESS/AGENCY:U,L.} (2'.Tu.C( 7m u <br /> ADDRESS: CITY/STATE/ZIP; K1a-Q+cr Wi , �A"AN(0 <br /> PHONE (1): - PHONE (2):(YO$)u22-�qAI FACSIMILE: (9Z-)q 31-72 7 <br /> TE TA IVE"APPOIN MENT DATE: Z, Zp(l Time: InA70 <br /> (Please allow 10 business days from date o appllcatlon auhm al-�Tontat'v.only-murt be confirmed) <br /> ❑CHECK DOX TO EXPEDITE R• EST•$125 FEF(CA I I OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ` - DATE 23 1 <br /> Electronic Information: ❑ LISt❑ Map—Description: <br /> FILE ADDRESS EHO USE ONLY <br /> Street# Stroet Name city <br /> �[ 1J a �p �,�, � Unll1 <br /> �{�/" Y/ 5 /Y nit2 <br /> 31 <br /> IUA <br /> 4. <br /> J711Unita <br /> � 6. <br /> ❑unit 4 <br /> 7. <br /> e. <br /> 9. <br /> 10. <br /> ❑Unit b <br /> Specific Date Range of Information Roquostod: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> Q OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORD$ ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-PRIOAY 5:00 AM-5:00PM(ExCLUDINo HOLIDAYS) <br /> 1. List up to ten_addresses in the space above. Select the type(s)of flies 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 mall to the address indicated above. Address <br /> ranges will not be accepted-for additional assistanoe 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 /> S. 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 appllcant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> :.Y L QN:y <br /> � <br /> EH aa.os "" enn+ <br />