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Apr. 8. 2008 15:34 BRDW-K & WINTERS No. 0660 P, 1/1 <br /> EHD LOG NUMBER <br /> DD - SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgV.Q 3eh,,q <br /> 3!51(o <br /> ��vf-kff HEALTH <br /> TX'1FRV10ES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I&A BUSINESSIAGENCY: ACV& <br /> ADDRr=$$:: <br /> PHONE 0 W4W!k PHONE(2)' FACSIM ILIE. <br /> TENTATIVE*APPOINTMENT DATE: ;T(-)y Time: IQ, <br /> (Please allow ten busi S ays from da*Of aPblication Submittal-*T@n18UVV only-must be confirmed) <br /> I f'OM <br /> CHECK BOX TO EXPEDITE RE EST)- 99.0�? FE- (CASHhk CHECK ONLY) REQUEST PROCESSED IN THRIE]4113UINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: List 0 Map-D6imbiption: <br /> FILE ADDRESS EHD USI~ONLY <br /> street# Stmt Name city C,Unit 1 <br /> %Jchn 2 <br /> (a <br /> 12- crCl Unit 2 <br /> 3. <br /> 4- 14. F <br /> 5. A %A 5,SA Ij-(A)d) (�,F6 <br /> W. r"VAVAf Sf. (eol") <JW b-1 C. <br /> 6. 1 11A..Ie^. {ShcIGA) r- F jMnit 4 <br /> 7. <br /> IDW lVrIF <br /> F"mf S-t— gbckh ta— )U r,r 13 Unit 5 <br /> t 6 <br /> Specific Date Range of Information Requested.From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> VMDERGROUNiiTANK(Ugn CLEANUP SITE(LOP) CI Housm',AsATFmpNv 1311<01.10 WASTE FAc;iLrrYNVHICLE <br /> o',HER CLEANUP SITE(NON-LOP) E3 FOOD FACILITY C3 WASTE TIRE <br /> IDERGROUND TANK(MOMMOIRINGIREMOVAL) E3 DOG KENNEL 13 DAIRY <br /> BPAAZARJ30UA WASTE GENERATOR 13 CHICKEN RANCH E3 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL E3 PUMPER TRUCKIYARDICHFM TOILETS <br /> 171 TATT00100VY PIERCING E3 POOLISPA 13 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILFrY M OTHER(PLEASE SPECIPY) <br /> WELL ANO SEpnq PERMIT RECORDS ARE AvAILA9LE FOR RLMEW- MONDAY-FRIDAY 8:00 AM-5:00081 -EXCLUDING HOLIDAYS. <br /> 1, List up to len addresses in the space above. Select the typo(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. f a kq i29214644t3&jormall to the above addrejA. 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 file*exist. An appointment for review will be confirmed approximately ten <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 8ctivaly being worked on by the EHD.stzrff 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 rile reviews by the same applicant May require.a$98.00 deposit prior to review. <br /> 12HO USE ONLY <br /> EHD48-06 18l2M7 <br /> PUBLIC RECORDS RELEASE APP FORM <br />