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03/-16/2007 15:10 FAX ID002 <br />EHD LOG NUMBER <br />I�V/ IIi �D) SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />[01, M, b 6 2007 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />LL_N�W� 11 It _ r, uTelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />I�IV`�I��\_I�dl'vryCiV�{ fJI� Y�I_I i l <br />p2 <br />�`�r'''"�`��-��ES PpUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: M Ic k i�e�� -C)CLS�L�Vh BUSINESS/AGENCY: G!nik,-t.-K,,AI t66 5octc,+,s <br />ADDRESS: 3N10 W. �G�'a"�-I �Cwe.��Ft F 15 6,1, 6q . GA 9521q <br />PHONE (1): (7_ -Cr() 13 ft -'777-Z PHONE (2): (7-0 1) 23q-7727 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal -'Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE RE T - 00 FEE (CAS OR EC ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE -311x107 cm <br />Electronic Information: ❑ List ❑ Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />HEALTH DEPARTMENT FILES <br />Street # <br />Street Name <br />City <br />E13Unit 1 <br />I. <br />1� <br />"1 .) 115 <br />1. I 1 <br />W o+g—r 6 c Pj !� <br />( <br />5' b (-k <br />2. <br />3 4 q <br />p p <br />(/l�a T+:t oo P A ,a J� <br />1 <br />❑ Unit 2 <br />3. <br />y X10 7 <br />W,i-e4- lot o 9n4 E <br />❑ POOL/SPA <br />Unit <br />4. <br />$ <br />i�nT�f too Pi <br />5• <br />755 <br />nn <br />NBf,-,&Qww <br />Unit <br />6. <br />1905 <br />N r- 1-k BrcPw' <br />- <br />7• <br />3 ti 00 <br />e� 1-D 11 I� <br />5�-n CA< -6 In <br />❑ Unit 5 <br />9. <br />❑ Unit 6 <br />10. <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />O SOUD WASTE FACIUTYNEHICLE <br />OTHER CLEANUP SITE (NON -LOP) <br />13 FOOD FACILITY <br />❑ WASTE TIRE <br />UNDERGROUND TANK (MONrrORING/REMOVAL) <br />❑ DOG KENNEL <br />0 DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILrTY <br />❑ MOTEUHOTEL <br />M PUMPER TRUCK/YARD/CHEM TOILETS <br />TATroo/BODY PIERCING <br />❑ POOL/SPA <br />❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABL.E FOR REVIEW - MONDAY -FRIDAY 8:00 AM-5:00PM - EXCLUDING HOUDAYS. <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 />