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SEP. 21. 2007 2: 12PM CO""-qR EARTH TECH N0. 4867 P. 1 <br /> DATE RECEIVED �4 <br /> x )410 LOG NUMBER <br /> ro E C S�V1�D SAN JoAqully COL <br /> ENVIRONMENTAL HEAL'))R DEPARTMENT <br /> SEP 2 1 200j 600 East Main Street, Stockton,CA 95202-3029 <br /> elephooe; (209)468-3420 Fax;(209)464-0138 Web:wwW.sjgov.org/ehd <br /> EhNIROINWIEfd( PiEAL?$UBLYC RECORDS RELEASE APPLICATION <br /> r n <br /> APPLICANT: BUSINESS/AGENCY: odor �' d✓� PS <br /> ADDRESS: <br /> PHONE(1): Q PHONE(2): FACSIMILE: " <br /> TENTATIVE*APPOINTMENT DATE: C fo �� � O Time: ^� <br /> (Please allow 10 business days from dais;'of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUES - 98.00 FlrE(CASH OR CH LY)-REQU CESSED IN 3 BUS NESS D YS <br /> SIGNATURE OF APPLICANT DATE 9 <br /> Electronic Information: ❑Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroat 0 Street Name CityEl Unit 1 <br /> 2. _ 7:� 5 A :J row a �� S a� ion �J�F'�� ✓ Unn2 <br /> 3. �Y40 C�ICZ P 0 <br /> S'�- � co� <br /> 4. `n de q a _ Unita <br /> 5. acv S-7' <br /> / p� G1c2/1 �C rl ®r, <br /> Unita <br /> 6. Vi=i c <br /> 7. <br /> 8. 73� 0- ❑ units <br /> 8. F F <br /> S f` 7�(7C' [9 — Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES . <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENTSOLID WASTE FACILITYNEHICLE .' <br /> $AZARDOUS <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 13 OLID <br /> TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) 173DOG KENNEL 0 DAIRY <br /> WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT z <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPERTRUCKIYARD/CHEM <br /> 0 TATTOO/BODY PIERCING ❑POOLISPA LAND USE APPLICATION SITES <br /> C7 MEDICAL WASTE FACILnY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AMv`:OOPm -EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Selo`"int the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be sel c6d. Fax to(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additio �sslstarr` with file addresses,contact the EHD"Applications received after <br /> 3:00 pm will be processed the next i ss ddy? <br /> 2. The EHD will notify the applicant _ Ht)-files exist nt for review will be confirmed approximately ten(10) <br /> days after receipt of application s will be held fo i Ive business days for review. Appointments <br /> should be scheduled according) <br /> 3. A file that is actively being wol on by EHD staff may not be imine I le 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 EH taff 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 /> EHo 4a-vo WEB 8/8/2007 <br />