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Apr-09-08 01:25pm From- -:1'-077 P-01/01 F-381 <br /> Y v EHD LOC,NUMBER <br /> AIR ��-. L„!�I� F DD SAN JOAQU�N CO NT'Y <br /> ENVIRONMENTAL:Hr_,ALTH DEPARTMENT <br /> . : 3!5 <br /> D -. ZOO 600 Fast Main Street, Stockton, A 95202-3029 <br /> Telephone:(209)468-3420 rax; (209)464-0138 Web: www.sjgov.or h <br /> '4'u' i; d vScP f HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION . <br /> APPLICANT. K �1e- tSh V1 BUSINESSIAGENCY: T � <br /> ADDRESS- C7� f7 c I��� D <br /> PHONE(1): (glko) SS3z -PHONE(2): C I SZ _LQ0 <br /> TENTATIVE*APPOINTMENT DATE: A Time:_�a6p_ •' ' <br /> (Pleaso 211nw 10 business days from date of applicatlon submi ttal-•Tentative only-must be confilm-d) <br /> CHECK BOX TO EXPEDITEREQ S8 0 FEE(C OR ECKt LY)-REQUEST PROCESSED IN 3 B SINESS DAYS <br /> SIGNATURE OF APPLICANT ' DATE Ll W A � <br /> Electronic:Information: [I List❑ Map-Descriptio <br /> FILE ADDRESS EHD USE ONLY <br /> Street 4 _street Name Unit 1 <br /> 2• ' N_ or lann1;- rte_ _mak zc I _ S "- R (adz !foil 2 <br /> 3. <br /> -4 _ — _ 4or <br /> Unit3 �\ <br /> 5' u it 4" <br /> _._..... <br /> T -- © units <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to _ <br /> ENVIRONMENTAL HEALTH DEP NRTMrzNT FILES <br /> t <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEM6'NT OLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) M FOOD FACILITY WASTE TIRENOERGROUND TANK(MONITORINGraEMOVAQ 0 DOG KENNEL M DAIRY <br /> AZARDOUS WASTE GENERATOR Q CHICKEN RANCH XWASTEINATER TREATMENT PLANT <br /> IERED PERMIT ED FACILITY 0 MoTELlHQTEL M PUMPER TRUCKIYAR01CH€M TOILETS <br /> 0 TATT0ol8oDY PIERCING ❑POOLISPA 11 LAND U5E APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY El OTHER(PLEASE SPECIE <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE F4R REviEw -MONDAY-FRIDAY 8:00 AM-6:00F m - Excl UDING HOLIDAYS. <br /> 'i. List up to ten addresses In the space above. Select the Type(s)of files from the list above by checking the approprlate <br /> box(es). At least one file type MUST be selected. Fax to(20914G4-0138 or mall to ha address indicated above. Addross <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 appointor nt for review will be confirmed approximately tan(10) <br /> days after receipt of appilcation. 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 imme4fiately 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 rtorga nixed by EHD staff at the expense of the applicant <br /> future filo reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> ENn 4044 wee EWN7 <br /> i. <br /> I <br />