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209-234-M Line 1 ^}16:03 05-06-2008 1 /1 <br /> DATE RECEIVED t./ SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> RECE EDD ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> MAY 0 7 2008 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ U <br /> ENVIRONMENT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 4cySay ��a t1¢ �� BUSINESS/AGENCY: O Oo/ <br /> ADDRES <br /> //S- <br /> � p9�/PS <br /> PHONE(i): D 5I PHONE(2): FACSIMI C E: _0-5' <br /> AO <br /> TENTATIVE*APPOINTMENT DATE: /"/4-� ��� r � Time: /(9 ACQP <br /> (Please allow ten business days from date of application submittal.*Tentative only-must be confirmed) <br /> EI CHECK BOX TO EXPEDITE REQUEST-$98.0 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSIN SS DAYS <br /> SIGNATURE OF APPLICANT DATE _5_/c/5 <br /> Electronic Information: ❑ Lis Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 Street Name city ❑unit 1 <br /> �. a 9D Se 7ck® <br /> 2. o o e v� ado <br /> 3. U;2.P ✓'2 r� 1 <br /> 6. / <br /> nit 4 <br /> 7. <br /> 8• 13 Unit 5 <br /> 9. <br /> 10, Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT XSOLIO WASTE FACILRYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKfYARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING CI POOUSPA XLANO USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIF1') <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 9:00 AM-5:00PM -EXCLUDING HOLIDAYS <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies 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 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 files exist. An appointment for review will be confirmed approximately ten <br /> days after receipt of application. The flies 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 /> can�anR 1MleiPl PIIRI r RFMRIIR RC1 F6 F APP M44 <br />