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06/03/2008 09:51 FAX 5302431654 CH2),I HILL Z002/002 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT -70 <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.o /e <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Utnn I ((7i(I,h _BUSINESSIAGENCY: C H 1 A Eld I <br /> ADDRESS: Z!62 6' A,;r�nur:� Q l- Bede-, L-1 14'n <br /> PHONE(1): PHONE(2): FACSIMILE: s j?.:.-339-324 3 <br /> TENTATIVE"APPOINTMENT DATE: bj 11 LV6 Time: 120V <br /> (Please allow tan business days from date of application submittal--7entadve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$96.00 FE (CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑Unit 1 <br /> 1. 3*�i3o _,.,5. tl0orticJla c"►a�f`.•1•on y v <br /> 2• 3`-l3� 5 r'aoC� Unite <br /> 3.j32Uz S, trrwAo i /U�.F <br /> 4. �a o �� I. Unit 3 <br /> S- F_, avcado C1 <br /> 6-V - S.la,, J c'ri <br /> 7• - 31 5 t Amradc `_ <br /> It ❑Unit <br /> 10. <br /> rr nit 6 <br /> 8b <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> n UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 HOUSING ABATEMENT SOLID WASTE FACILITYIVEHK:LE <br /> Ui THER CLEANUP SITE(NON-LOP) ❑FooD FACILIrr dwasTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) O DOO KENNEL ❑DAIRY <br /> [[[[[[.000000]]]]]],/HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH C3 WASTEWATER TREATMENT PLANT <br /> G TIERED PERMITTED FACILITY ❑MOTEL/HOTEL 0 UMPERTRUCK/YARDICHEM TOILETS <br /> ❑TATTO0IBODY PIERCING ❑POOL/SPA V LAND WE APPLICATION SREs <br /> ❑MEDICAL WASTE FACILITY 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 type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 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 will <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 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 40-06 10129107 PUBLIC RECORDS RELEASE APP FORM <br />