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Jan 05 09 07: 35p <br /> DATE RECENEO V EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgo <br /> PUBLIC RECORDS RELEASE APPLICATIO <br /> APPLICANT: its 5e)"I / BUSINESSIAGENCY: <br /> ADDRESS: - t1��C� 41 �Ju r l���v ` ��+��� /<� CitylState2ip _, ✓� !' ✓i - - <br /> PHONE(1): 0L)'f- Ll_`z I to f PHONE(2): �1 3 L' S �� —FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Ploaso allow 10 business days from date of application submittal-'renta[rve only-must too confirrnfod) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 05 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DACE 1, <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> streatI Street Name City ElUnit 1 <br /> F <br /> El Unit 2 <br /> 3. <br /> 4. - Unit 3 <br /> s. Unit 4 \ <br /> 7' unit 5 <br /> 8. _ <br /> 9. <br /> � Unit$ <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Lr i <br /> UNDERGRouND TANK(UST)CLEANUP SITE(LOP) E3 HOUSING ABATEMENT C3 SOLID WASTE FACILITYNEHICLE <br /> �iyt� <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITv 0 WASTE TIRE ; <br /> UNDERGROUND TANK(MONRORINURF-MOVAL) 17 DOG KENNEL 0 DAIRY <br /> Q HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 17 TIERED PERMITTED FACILITY a MOTELIHOTEL C3 PUMPER TRUCKIYARDFCHEM TOILETS <br /> 13 TATTOOIBODY PIERCING 171 POOLISPA 13 LAND USE APPLICATiaN SITES <br /> C3 MFuicAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:40 AN-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 mall to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with fife 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 neva application may be <br /> submMed 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$905 deposit prior to review. <br /> EHD USE ONLY <br /> I <br /> I <br /> I <br /> EHD 08-46 8144108 PUBLIC RECORDS RELEASE APP FORM <br /> i <br /> . I <br />