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DATE Ma.r. 1 2009 9:54AM anceGeoF_iivironmental No. 4495EHO '_ 1NQMBER <br /> SAN JOAQUIN COUNTY <br /> 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> I <br /> PJR '-j t Telephone: (209)468-3420 Fax: (209)464-0139 Web: www.sjgOV.04r <br /> P'U BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C-01A#44- SUSINESSIAGENCY: <br /> ADDRESS: �- skaj U . �c"PVL <br /> PHONE(1): 1-1120& PHONE(2): WC-3q0l —FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: ely& Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RFQU ST- 9 0 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> % 3 <br /> SIGNATURE OF APPLICANT DATE /1,/'r <br /> Electronic Information; ❑ List[] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street it Street Name I <br /> Fcity ❑ Unit_- IWPUZI It 2 <br /> 2. 40p, <br /> 3. E1 Unit3 <br /> 4. <br /> ....... Unit <br /> 6. <br /> ....... Unit 4 <br /> 7, El Unit 5 <br /> 8. <br /> 9. ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT M SOLID WASTE FACILiTYNEHICLE <br /> 11 OTHER CLEANUP SITE(NON-LOP) 13 F000 FACILITY 0 WASTE TIRE <br /> 11 UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL WASTEWATER TREATMENT PLANT <br /> 173 HAZARDOUS WASTE GENERATOR El CHICKEN RANCH !LETS <br /> El TIERED PERMITTED FACILITY LET <br /> M MOTELIHOTEL 4�u�u��, <br /> 11 TATTOOIBODY PIERCING 0 POOL/SPA 0 LAND USE APPLICATION StiEs <br /> 0 MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY B:00AM-5'00Pm - EXCLUDING HOLIDAYS, <br /> 1. List up to ton 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 now 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 /> EH049-06 WEB S18/2007 <br />