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09/26/2008 14:49 FAX 559 442 5081 KLEINFELDER Q002/002 <br /> r , 1 <br /> M(� i -SAN JOAQU€311 COUNTY EHD LOG NUMBER <br /> SEP 2 6 2008 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONMENT HEAL' Iephone: (209)468-3420 l=ax: (209) 464-0138 Web: vA".sjgov,org/ehd <br /> PFR10 f SERVICE-1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> }}-S <br /> BUSINESSlAGENCY: ; ly <br /> ADDRESS: f -SI,i I',., <br /> �.I...1�-�:;L <br /> f G. <br /> PHONE(1): �' `�Ct� �� i PHONE(z): :`_?` '-%"I C V 7 —FACSIMILE; <br /> h..... _ ,._, <br /> TENTATIVE"APPOINTMENT DATE:;, Time:_ <br /> (Please allow ten business days f1ro'm -Tentative date of application submittal only-must be confirmed) <br /> © CHECK BOX TO EXPEDITE REQUEST-'$98.60 FEES(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE <br /> Electronic information: ❑ List❑ Map -Description: <br /> FILE ADDRESS Et-tll USE ONLY <br /> Street# Street Name City <br /> Unit 1 <br /> 2i' � t, �t/i �I/fj�! /s1? Gf.;{' ' /t/. <br /> —�I � IGLL[' ��t� J7rl �e r. r 0 Unit 2 <br /> , it 3 <br /> 4 <br /> 7. < nit 4 <br /> I <br /> 10' I I �Unit6 <br /> t <br /> Specific Date Range of Information Requested: From �`•�. ;'�; to <br /> ENVIRONMENTAL HEAD TH [3EPARTMENT FILES - <br /> .'L-I UNDERGROUND TANK(UST]CLEANUP SITE(LOP) 4n HOUSING ABATEMENT ❑SOLID WASTE FAGILnYNEHICLE <br /> �THER CLEANUP SETS(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> �/UNDERGROUND TANK(MONITORINGIREgAOVAL) ❑ DOG KENNEL ❑DAIRY <br /> /�',HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH M WASTEWATER TREATMENT PLANT <br /> ,0'TIERED IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARO)CHEM TOILETS <br /> ❑TATTob7BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑!MEDICAL WASTE FACELITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY-FRIDAY 8.00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List Up to ten addresses in the space above, Select the types of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-0136 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses, contact the EHD. Applications received after 3:00 pm wilt <br /> be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review wilt 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 actively being worked on by the EHD staff 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 file reviews by the Same applicant may require a $98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46,06 10f29fQ7 - <br /> PLISLIC RECORp$RELEASE APP FORM <br />