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6-12-07; 12:37PM; � � ;2099836960 # 2/ 2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> { S N UI6' , -j1Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E. Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: 4Fifi`46 <br /> ADDRESS: 202 0"I <br /> PHONE(1): 2 -q 9rr3 -G 81 o PHONE(2): FACSIMILE: C9G t7 <br /> TENTATIVE"APPOINTMENT DATE: Afore Time: fJN: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE EST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> { SIGNATURE OF APPLICANT % DATE ��/6 7 <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 00rUnit 1 <br /> 2. <br /> unit 2 <br /> 3. a1 <br /> 4 Unit 3 tJ <br /> -- --- Unit 4 <br /> 6. <br /> 7' nit 5 <br /> 8. <br /> 9. ,o° fix: <br /> 10. <br /> "h <br /> Specific Date Range of Information Requested: From q& to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> :l]UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT 1`J SOLID WASTE FACILITYIVEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY l2r WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL RI DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 7 MOTEL/HOTEL PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOO/BODY PIERCING 7 POOLISPA �(..AND USE APPLICATION SITES <br /> )ZI MEDICAL WASTE FACILITY )2r OTHER(PLEASE SPECIFY) 4ny {.'/s Jr a. S:T <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 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 /> EHD 48-06 9/13/2006 Web <br /> I <br />