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MAR. 20, 2008 10:32AM F;PSON3-925-979-9781 NO 6701 P. 1 <br /> EHD LOG NUMBER <br /> Q.4TFr,fiEXVi" r SAN JOAQUIN COUNTY MAR 2 0 2008 <br /> L� I �� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 21108 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:w, 'i'ov.o e <br /> 7Z <br /> �- PUBLIC RECORDS RELEASE APPLXCATIO <br /> APPLICANT: BUSINESSIA,GyENCY:12:5-"l <br /> yy� Q <br /> ADDRESSVim <br /> . rLI"Y7f/b%S1 G �AI�JI/IL! Jr� -L <br /> PHONE(1): /27' lg�l�L� 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-$98.00 FEE(CASH 0 CHECK ONLY)-REQUEST PROCESSED IN 3 USIN�SS�DDA"yS <br /> SIGNATURE OF APPLICANT DATE r✓a <br /> Electronic Information: [] Llst❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 3tree!# Street Name City Q Unit 1 <br /> 2 ❑ Unit2 <br /> 3. <br /> Unit 3 <br /> 4. G <br /> 5. <br /> Unit 4 <br /> 6. <br /> 6. <br /> 7. <br /> ❑ una s <br /> B. a <br /> 9. ❑ Unite <br /> 10. <br /> Specific Date Range of Information Requested;From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IIUNOERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOuo WASTE FACILITYNERICLE <br /> VHER CLEANUP SITE(NON-LOP) M FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONIYORINGIREMOYAL) 0 DOG KENNEL ❑DAIRY <br /> CI HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 0 MOrEUHOTEL 0 PmPERTRUCKIYARDICHEM TOILETS <br /> O TATTOO/BODY PIERCING MYOOUSPA 0 <br /> 0 MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFYrnw %=M <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvipw - 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)464-139 or mall to the address Indicatedabove. 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 len(10) <br /> days after receipt of application. The files will be held for a maxlmum 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 now 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$96.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD4e4ewEa 5e2007 <br />