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Fm:MyFax-Tabbitha Croy To:File Review Req`lest(12094640138) 20:24 05/08/08(CNIT-04 Pg 02-02 <br /> UC1129 EU SAN JOAQUIN COUNTY EHD LOG NI 'BER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y E;Y 0 9 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org! 4ENVIRONMENT HEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �C'j'�:J i 1 I`-'✓l BUSINESS/AGENCY: (.,_• )(...=,t.,LC a l t �(_'E <br /> ADDRESS: \!('. �..... Il til ('` " L' [I <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: i l 1(v� <br /> (Please allow ten business days from date of application submittal-'Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-.,$98.00 FEF,,.(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS D S <br /> SIGNATURE OF APPLICANT ik DATE <br /> Electronic/•formation: ❑ List❑ Map- Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name { City ✓2 Jnit 1 <br /> -- <br /> A�J�vj_ <br /> 2• lnit 2 <br /> 3 <br /> 4 ..... <br /> - -- <br /> 6 Jmt 4 <br /> 7. <br /> _.. _...........--....... <br /> . <br /> 10. Y �/f/Il( 1 Mit6 <br /> i- ✓ <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> •UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE 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 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 pry rill <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; 1. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> 5 Iq I>11�s AyaIlo�oT uk u Ixc�c+� ova tv��c0�.� <br /> -- -- - _ <br /> EHD 48•06 10/29107 PUBLIC RECORDS RELEASE, FORM <br />