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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 //n f �j <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or# L(��/ <br /> PUBLIC RECORDS RELEASE APPLICATION r r <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: (n rUQ m(A.c-VV S'{" CITYISTATE2IP <br /> PHONE(1): 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-$105.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street It Street Name city ❑ -- <br /> t4qW 'S 4LUL, Cj R 5414 <br /> 2. � unit z <br /> 3. (\); i-79 2-ao3 2 <br /> 4. ❑ Unit 3 <br /> 5. <br /> 6. "/ /07. <br /> $9.10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> O OTHER CLEANUP SITE(NON-LOP) 0FOOD FACILITY 13 WASTE TIRE <br /> 0 UNDERGROUND TANK(MOMTORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOL/SPA 0 LAND 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:OOPM - 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 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> """If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You`" <br /> END 48-06 8/Oa/2008 <br />