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on,rE RECEIVED <br /> SAN JOA UIN COUNTY C�CE II '� <br /> ENVPKONMENTAL HEALTH DEPART11I-wvT <br /> 600 East Main Street, Stockton, CA 95202-2708 1 2008 <br /> Telephone: (209) 468-3420 rax: (209) 464-0138 Web: www.sigov.org/chd _ <br /> i,:l iti HEALTH. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:—PAL y- vc- BUSINESS>IAGENCY: <br /> ADDRESS: <br /> PHONE(1): l. -�o���- PHONE(2): FACSIMILE: <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 REQUEST-$98,00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTIi� /--- <br /> DATE <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City' ❑ Unit i <br /> 1. .Z �• s�-� �2� �S�IO4.` <br /> 2. <br /> Unit 2 <br /> 3. <br /> 4. Unit 3 <br /> 6. Unit 4 !!I <br /> 7. <br /> 13. EljUnt6 <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> F <br /> UN RGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 2 SOLID WASTE FACILITYIVEHICLE <br /> CLEANUP SITE(NON-LOP) 0 FOOD FACILITY PVYASTE TIRE <br /> UN ROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL Cl DAIRY <br /> AZARDOUS WASTE GENERATOR M CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL CI P MPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA -,., LANO USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-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 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 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 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> If you should need further assistance please contact Diane Martinez G (209)468-3425 directly. Thank You*** <br /> EHD 48-Q6 9714120/)6 <br />