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Fm:MyFax-Tabbitha Croy To:File Review Request(12094640138) 20:24 05/08/08GMT-04 Pg 02-02 <br /> nD EMI V j�!� EHD LOG N! BER <br /> (i71�CG1/Ilr�IlIJ1J1 SAN �IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> alE� 0 9 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ d <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: ��)t�Ji l i� (r!i <br /> / `B` USINESS/AGENCY: <br /> ADDRESS: ` ZJ­\""" ��(^t 't \�::1, U L\�f( ( �:c X L 1 Lit �t ,t,) rc-I-5 I <br /> PHONE(1): I / ; .1 I C1 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: CI Ci Time: <br /> (Please allow ten business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$98.00 FE&_(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS D S <br /> SIGNATURE OF APPLICANT DAVE > i UI <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESSEHD USE. ONLY <br /> _... .. ....... .......... _ <br /> Street#_ Street Name City Jnit 1 <br /> �r\� .c_G` 3. ,r� a �5 <br /> —-----......... l <br /> 2. - - Inst <br /> 3 <br /> 4. T <br /> __.. nit 3 <br /> 5. <br /> -- <br /> ...-.......... <br /> 6- i Jnit 4 <br /> 7. <br /> - . . <br /> 8. <br /> Jnit 5 <br /> 9. <br /> ......... <br /> 10. : Jnit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 0 POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-S: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 appropria <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the above address. Address range will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pn fill <br /> 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 t <br /> (lays after receipt of application. The files will be held for a maximum of five business days for review. Appointmen <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 applicati <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 applic: t. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> f <br /> — <br /> EHD 48-06 10/29/07 --- PUBLIC RECORDS RELEASE, FORM ' <br />