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07 / 11 / 2007 15 : 16 13107982 ' ' 1 PAGE 02 <br /> DATE RIVIRP EHD LOG NUMBER <br /> _ SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3 - - 600 E. Maize. Street, Stockton, CA 95202-3029 <br /> �j plepbonez (209) 468 -3420 Fax. (209) 464-0138 Web : www.sjgov <br /> 0 <br /> r:, PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCAHT: /yam N- C� � � F �r.--, __ BUSINESS/AGENCY: <br /> ADDRESS: Z1 C%2 <br /> PHONE (1 ) • `j7 295 C1 PHONE (2) : f'��� 3.g t:�? � � 27 I FACSIMILE: - <br /> TENTATIVE* APPOINTMENT DATE: Tama: . . <br /> (Please allow 10 business days from data of applicAtlon submittal w * r0nMftVa only - must be confirmed) <br /> 12 CHECK BOX TO EXPEDITE REQU $9S FEE (CASH ORCK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT :�� ��/w�i' DATE <br /> Electronic Information : ❑ List ❑ Map - Dascrlption : <br /> FILE ADDRESS EHD USE oNLY <br /> Street # Street Name city ❑ Unit 1 <br /> FIRM I <br /> F26 <br /> �� I 3- l� r�, M� Q TYti� . d awl <br /> ❑ unft 2 <br /> 4. <br /> 5. Unit 4 <br /> 6 , <br /> 7, <br /> lool Unit 5 <br /> 8. <br /> 9 , <br /> Unit 8 <br /> 10 , <br /> Specific Date Range of Information Requested : From A 1 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNneRoROUNb TANK (UST) CLEANUP SITE (LOIS) © HOUSING ABATEMENT I% SOLID WASTE FACILrTYNFHICLE <br /> ,y(WOTHER CLEANUP SITE (NON•LOP) M FQoo FACILITY In WASTE TIRE <br /> ONDERGROUNP TANK (MONITORIN ©!REMOVAL) M Doo KENNEL y0 DAIRY <br /> Ig HAZARbOUA WASTE GENERATOR E3 CH )ICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERmrma FAcn nY G (IIoT>(?L(HOTEL G Pum PIER TRUCKIYARDICHEM TOILETS <br /> 0 TATWO1130nY PIERCING M POOLISPA © LAND USE APPLICATION Saadi <br /> G mcoicAL WABTr FACILITY 0 OTHFR (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARe AVAILABLE FOR REVIEW • MONDAY-FRIDAY 8&00 AMp:OOPM - EXCLUDING HOUDAYB, <br /> 9 . Llat up to ten addresses in the space above , Saiect the type(s) of files from the list above by checking the appropriate <br /> box(aa) . At least one file type MUST be selected, Fax to (209 ) 464.0138 ar mall totheaddress. Indl.catLc p(�v�e , Address; <br /> ranges will not be accepted — for additional assistance with file addresass, contact the EHD. Applications racelved after <br /> 3: 00 pm will be processed the next business day. <br /> 21 The EHO will notify the applicant if any EHD files exist, An Appointment for review will be confirmed approximately ten (10) <br /> days after receipt of applica#Ion. The flies 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 appllcadon may be <br /> submitted when the file Is available , <br /> 4. Any file not returned In the same condition as released will bo reorganized by EHD staff at the expense of the appllcent. <br /> Future file revlews by the same applicant may require a $95.00 deposit prior to review. <br /> EHD USE ONLY <br /> MONOMER <br /> EH04E46 9113f20Q6 web <br />