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06/30/2009 11:38 2094728F' INSITE ENVIRONMEN- IL PAGE 01/01 <br /> - 4 REycrIV;.P `� �l EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JJN 5 0 2099 600 East Main Street, Stockton, CA 95202-3029 <br /> LL Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or <br /> PEIRI I1 /SLEP,V;Ci ,� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: V't BUSINESS/AGENCY: In It e_ vtrp,nt"I�eI�-r.i� <br /> ADDRESS: d ' I City/stat./Zip S z( <br /> 41 <br /> PHONE(1): Zaq- L47?_— T ;, Q PHONE(2); .13 09--147Z— Op� <br /> 6' <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 FEE CASH OR 71<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 9 ^ Street Name City <br /> Unit�.1104t 1 <br /> 3. 0� -! UJLI-� J f E) Unit 2 <br /> 4, Unit 3 <br /> 5. <br /> 6. Unit 4 <br /> 7. <br /> $ ❑ 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 \M SOLID WASTE FACIUTyNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY M WASTE TIRE <br /> UNDERGROUND TANK(MONITORINWREMOVAL) D DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ©TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> C3 TATTOOIBODY PIERCING r,POOLISPA In LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY L7 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. Eax 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 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 8/04/08 <br /> PUBLIC RECORDS RELEASE APP FORM <br />