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02/25/2009 WED 10: 05 FAX 2094682999 SJC Public Works 120011001 <br /> T'l`Rl F9 71/ I j EHD LOG NUMBER <br /> 1 - SAN JOAQUIN COUNTY <br /> �, .,,�c ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` E-LB '' G `00119 600 East Main Street, Stockton, CA 95202-3029 <br /> i <br /> i :aL(!? <br /> ,Telephone: (209)468-3420 Fax:(209)464-0138 Web:WWW.Sjgov.org <br /> 4 ( 5 <br /> r Ehd`'Jlf3tl!lti1tl'+ i <br /> I t ERMI /SMVICES <br /> PUBLIC RECORDS RELEASE APPLICATION p, / <br /> APPLICANT: - _V_ BUSINESSIAGENCY: <br /> ADDRESS: _J 0>'� Lr Tldt2-���.� V-C Cityistaterzip <br /> PHONE(1): Og 414 —30 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 70 EXPEDITEARET-§1 F�AHCK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� DATE <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY n / <br /> Street# Street Name City �� )) V <br /> ST f�GLC /(/r F Unit \ ` <br /> 2' 3 v ra.1t L Stye 1 ro.c �2 91�0 Unite 1� <br /> t 3. 3 5ge <br /> 4. Q nit <br /> 1 6. u r Unit 4 <br /> 7. '�,yb y L c, NLO 0. ( Low f�•�o <br /> Unit 6 <br /> g1r33F <br /> i a it It". y.CIA' r ./— © Unit 6 <br /> 10. <br /> Specific Date Range of information Requested:From to <br /> 1 ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> +UNDERGROUND TANK(UST)CLEANUP SITE(LOP) AHoUsiNG ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) )0ZFpOD FACILITY 0 WASTE TIRE <br /> - UNDERGRouND TANK(MONITORING/REMOVAL) 0 DOG KENNEL Q DAIRY - <br /> f AZARDOUS WASTE.GENERATOR ❑CHICKEN RANCH 17 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY :MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM To1LETS <br /> TATTOO/BODY PIERCING ❑POOLISPA El LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILASLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-5:OOPM -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 /> 1 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 /> i 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant <br /> I Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> i <br /> i EHD USE ONLY <br /> EHD 48-06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br />