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WE_REACEIVED, EHD LOG NUMBER <br /> IDI SAN .TOAQUIN COUNTY <br /> LF1.—,�`t,7,cf,d �J L�„Vi <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 1 9 2008 600 East Main St. Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENViR0Niv`I1_P,;I i-iEk"rN <br /> FR 1 .!51FRV!GFS PUBLIC RELC,ORDS RELEASE APPLICATION <br /> APPLICANT: / 9 ! S BUSINESS/AGENCY: zu.07• C <br /> ADDRESS: 6-X06 �_9A/J8fP Y ./n. _ CITYISTATElZIP Zj:17 g0� A FSA./a - 95/J7 <br /> PHONE(1):o?07- PHONE(2): .Z0 - /S 3 �� FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: " . f f fix 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 9R CHECK ONL ) EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> i <br /> SIGNATURE OF APPLICANT sh. DATE LO-P <br /> l Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Nam <br /> e city _ ❑ Unit 1 <br /> /I/jl/ <br /> 2. 01000/0 <br /> unit 2 <br /> 3. <br /> 4. ^ d Q�f ❑ Unit 3 <br /> 5, Q� <br /> ❑ Unit 4 <br /> 6. <br /> 7. <br /> ❑ Unit S <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT ❑ SOLID WASTE FACILITYIVEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ©WASTE TIRE <br /> E3 UNDERGROUND TANK(M ONITORINGIREMOVAL) 13 DOG KENNEL Q DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL CI.PUMPER TRUCKIYARDICHEMTOILETS <br /> 0 TATTOOIBODY PIERCING ❑ POOL/SPAAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY © OTHER(PLEASE SPECIFY)_t7— <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 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 /> i <br /> EHD 4&06 810412008 <br />