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02/23/2007 15:27 FAX 40 41 <br /> 0 002 <br /> SAN JOAQUIN COUNTY <br /> DATE RECEIVED EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> JJ,, <br /> PUBLIC RECORDS RELEASE APPLICATION ` <br /> APPLICANT: �7NILr� K¢.Ai-- 90,SNgm r r� BUSINESSIAGENCY: fJa��2GQ.— Kwk I ± AS-TOG• <br /> ADDRESS: '7'f/0 /J). oW.t �.Nt t lui�c Ll Sf-yt tk DA , CA 45'Z19 <br /> PHONE(1): (Mi) Z34`772Z PHONE(2): FACSIMILE: (ZC9) Z3y-7727 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> E3 CHECK BOX TO EXPEDITE RE/� $95.00 FE (C H R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT (_ ��� � DATE 2/23L07 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 4 Street Name City ❑ Unit 1 <br /> se P Gr 4l <br /> 2. ❑ UnR2 <br /> 3. :A4,11 (rwl V, µ�eOi <br /> Unit 3 <br /> 4. <br /> Pi�/c/�14t 5 r r " <br /> 5• 70 S Pa i� r1Yt P,z S olirUnft4 <br /> 6. / <br /> 7. <br /> ❑ Unit5 <br /> 8. <br /> g. ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tNDERrROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑SOLID WASTE FACIUTYIVEHICLE <br /> OTHER CLEANUP SITE(NON•LOP) E3 FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCK/YARD/CHEMTOILETS <br /> 13 TATTOO/BODY PIERCING ❑ POOLISPA ❑LAND USE APPLICATION SITES <br /> 11 MEDICAL WASTE FACILITY ❑OTHER PLEASE SPECIFY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:60PM - 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 address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <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 EHD staff may not be immediately available for review. A new application may be <br /> 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD48.06 91130006 --- <br />