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05/10/2008 09:54 916446"13 MATT PAGE 01 <br />DATE R CEIVED FHl] LOG NUMBER <br />SAN .JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, GA 95202-3029 '� 7Telephone: (209) 468-3420 Fax: (209) 4134-0136 Web: www.sigov.org/e d <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: MA 7(� l BUSINE3SlA0ENCY:L C ! N��i f <br />/ +� �{ <br />ADDRESS: i 7 LE U � �- L= sU �% ( 5 �{ 1z'+-16^1 /-0 G/ 9sel r�' tjct'(;F S <br />PHONE (1):. q1 G qj+& 3 e 3 PHONE (2); FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: 5--2-7-ve Tlme: °I 30 1q"1 <br />(Please allow ten business days from date of application submittal -Tentative only -must be confirmed} <br />© CHECK BOX TO EXPEDITE REOUES00 FEE ASH OR CHECK ONLY) -REQUEST PROCESSED IN THREE BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # <br />Street Name <br />..•...,.. <br />Clry� <br />_._----..__ <br />©Unit 1 <br />Ix <br />0 <br />W (c_5o_) wily 5ifilY <br />5 <br />2' <br />I ICxJ <br />/o '-fa <br />"'gNitC'9 <br />t.'C� l+l�°r�� tl �ry}j. ❑ Unit 2 <br />der tr7T? 5 M1 . d) .:; . <br />3. <br />I 13 <br />E_ (_-�Lflvrw W9i <br />5 i UCkT4j <br />4. <br />/ <br />W +Q?i=Q L.dp <br />6. <br />Pilr�t/� <br />u7 <br />Unit4 <br />L77. <br />Ounit 5 <br />14, <br />❑ Unit 6 <br />igfoo <br />cl- 6� <br />Specific Date Range of Information Requested: From (I C -L- to fl2e5&' <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />X01 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYfVEHICLE J <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br />UNDERGROUND TANK (MONITORINGlREMOVAL) 0 D KENNEL 171 DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Q WASTEWATER TREATMENT PL NT }�—/ <br />,ECTIERED PERMITTED FACILITY 11MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS 6/ ZZ J06 <br />❑ TATTOO/BODY PIERCING El POOLISPA }�, ❑ LAND USE APPLICATION ITES , /J� CSC <br />O MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) ���/ r"� 12 -46 T i � ( 7 r �f7/4 <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM•6:00PM - EXCLUDING HOLIDAYS. <br />1. List up to ten addresses in the space above. Select the type(s) of flies from the Ilst 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 above address. Address ranges will <br />not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm will <br />be processed the next business day. <br />2. The EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed approximately ten <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 the EHD staff may not be Immediately available for review. A new application <br />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 applicant. <br />Future file reviews by the same applicant may require a $98.00 deposit prior to review. <br />EHD USE ONLY <br />l - 6 -W <br />EHo 49-06 1012707 _-�..., PUBLIC RECORDS RELEASE APP FORM <br />