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209-234-0538 Line 1 .� 16:03 05-06-2008 1 /1 <br /> RIFICM <br /> DArE RECEIVE`,D��/RLJ <br /> EHD LOG NUMBER <br /> �"/ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> MAY 0 7 2008 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION / J <br /> APPLICANT: �dSU� /��01�¢ �� BUSINESS/AGENCY: O Ovl /52-F% T4-44029 �S <br /> ADDRESS: �O /`r`�/!K WeSf C,- chi J7 <br /> PHONE�1): `7 Q S� PHONE(2):/n �c FACSIMI E p S� <br /> TENTATIVE*APPOINTMENT DATE:. / /Q7� 6ZOi 0(92 Time: � <br /> (Please allow ten business days from date of a plication submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$98.0 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 5' <br /> Electronic Information: ❑ Lis Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City O Unit 1 <br /> a o ,`so <br /> 2. po e v� } <br /> Unit 2 <br /> 3. 5S� v -P . ✓ - q f ✓� - <br /> 4. .2 <br /> m l-, F Unit 3 <br /> 5. <br /> 6. ) <br /> 7. nit a 111 <br /> 8. ❑Unit 5 <br /> 9. <br /> 10• Unit 6 <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 ❑MOTEUHOTEL CI PUMPER TRUCKNARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPALAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> JK <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 /> CYn AA1 A 4417G//17 <br /> V,'A,r RF/RF:RFI FCRF CPP I:OQAA <br />