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02/13/2006 10:32 FAX Z002/002 <br /> DATE RECEIVEDEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRoNMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0139 Web:www.sjgov.org/ehd (// 7 <br /> PUBLIC RECORDS RELEASE APPLICATIONj� � &a <br /> APPLICANT: BUSINESSIAGENCY: /�(-Je1 'j\ <br /> ADDRESS: 2-8 p��o M �Q i S i CITY ZX::t_ "o p� STATE_CA <br /> S <br /> 614 <br /> PHONE(1): 2 'A— IQ �Ir PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: app �D �n _Time: <br /> (Please am 10 business days from date of llCaH cubmtt al-•ranwave only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ ST- 93.00F Az <br /> OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINE:S DAYS <br /> IIL� <br /> SIGNATURE OF APPLICANT z DATE — <br /> Eleclwnk p Uct ❑ Map-Descrlptlon <br /> InformatloR <br /> FILE ADDRESS EHD USE ONLY 1,G <br /> Stn.t f Street Name my <br /> 1. ❑ Unit 1 <br /> 2• ^nit 2 <br /> 3. <br /> 4. Unit 3 I <br /> G. Unit 4 <br /> z <br /> 117� <br /> 6_ O Unit 5 <br /> s <br /> 10. L I I El Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �NDERGRDUND TANK(UST)CtEmur SmT (LOP) 13 HOUSING AeATEMENT O SOLD WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON-LOP) C1 FOOD FACILM OWAST'E TIRE <br /> U.PNDERGROUND TANK(MONrTORINGIREMOVAL) Q DOG KENNEL- rPAIRY <br /> HAZARDOUS WASTE GENERATOR 0CHmN RANCH irk WASTEWATER TREATMENT PUNT <br /> •TIERED PERMITTED FACILIrf 0MOTWHOTEL MPUMPERTRucK/YAXDICNEwC:AL.TotLETs <br /> ❑TATToo(BODY PIERCING ❑POOLISPA 13 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAaARLE FOR RPAIEW-MONDAY-FRIDAY E:00 AMS:00PM - EXCLUDING HOLIDAYS. <br /> x' <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the <br /> •'appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD. Applications received after 3:00 pm will 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 <br /> approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submitted when the Elle 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 4BAS <br />