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05/15/2008 14:27 2133800505 ENVIRONMENTAL PAGE 01/01. <br /> Ht� <br /> U r � SANJOAQU•IN COUNTY <br /> [-5) <br /> SAN I� <br /> OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> taiF�' QQB 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2709 $ <br /> Telephone; (209)468-3420 Fax; (209)464-0138 Web:'www.sjgov-0r9/ <br /> �1 N� A�ZK _ 'j,MMENT's? -A��.. <br /> E;��If.i �ERVlc�s PUBILIC ECOItDS RELEASE APPLICATION FRR9 <br /> APPLICANT- 1 DUSINESSIAGENCY: ''c Esr <br /> ADDRESS: SS 'V',E <br /> 4 v h �C <br /> PHONE 111: - �l��� PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tanfmive only-must be confinned) <br /> CHECK BOX TO EXPEDITI REQ EST $9 0 FEE(C H R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS.DAYS <br /> SIGNATURE OF APPLICANT - BATE ntd,25_ <br /> Electronic Information: ❑List❑Map–Description:, <br /> FILE ADDRESS EHD USE ONLY <br /> Strset Street came City Ca Unit t <br /> 1- 1�35 <br /> 2- 1,. 45 Unit 2 <br /> 3. <br /> Unit 3 <br /> 6. <br /> 7. <br /> .0.._unit <br /> 8. <br /> r <br /> 9- uhlt I: <br /> 1 D. <br /> Specific Date Range of Information Requested:From to , <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANTS(UST)CLEANUP 54TE(LOP) ❑HoustNa AeA-rEMENT ks=Tna <br /> LID WASTE FACILI'IYIYEHICLE <br /> ER CLE?ANUP SYrE(NON-LOP) FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) M DOG KENNEL 0 DAIRY <br /> AzARD4us WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> MUD PERMITTED FACILITY MOTELIHOTLL PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTDOIBODY PIERCING ❑POOLlSPA ❑LANDUSE APPLICATION SITES <br />[ ❑mraiGAL wA6TE FACILITY ❑OTHER(PLEASE SPECIM <br /> WELL AND SEPTIC-PERMIT RECORDS ARE AVAILABLE:FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:0OPM - EXCLUDING HOJJDAYS. <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(esl. At least one file type MUST be selected. Fax to f209)464-0138 or rngil to the Andress indicated_ahoys. Address <br /> ranges will not be acceptod--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 EHO will notify the,applleant if any EHD filers exist. An appointment for review will be confirmad approximately ten(1 D) <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 filenot 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$95.00 deposit prior to review_ <br /> EHD USE-ONLY <br /> EHD 48-08 1032608 <br />