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-17 w a <br /> t}YlfVVM[StK <br /> DATE RECEIVED SAN .TOAQUIN COUNTY ` 9 <br /> ENVIRONMENTAL HEALTH DEPARTM T <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telepho . ( 9) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> 2005 APR 26 AM 10: 11 <br /> PUB RECORDS RELEASE APPLICATION <br /> APPLICANT: k / BUSINESS/AGENCY: ~ENVIRONIMLNTAL <br /> ,/ t <br /> PWRTrFNT— <br /> /t ADDRESS: >// <br /> PHONE(1): ''Ll / 7 3 Z(Y PHONE(2): OI— aJz to FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dAte of a Nication submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU T-$93.0 F ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 US ESS DAYS <br /> SIGNATURE OF APPLICANT a DATE � <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 0 Unit 3 Cl Unit 4 0 Unit 5 0 Unit 6 O Other(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> WJ �Street <br /> # r Street Name �o City <br /> 1. 64'70,')?n� <br /> 3 <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT O SOLID WASTE FACILITY/VEHICLE <br /> THER CLEANUP SITE(NON-LOP) 1:1FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL ❑ DAIRY <br /> L1 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH _ O WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY O MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> El TATTOO/BODY PIERCING O POOL/SPA ❑ 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted —for additional assistance with file addresses, contact <br /> the EHD. Applications received after 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 <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> EHo�e-ozaa <br />