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v4t1o/4vio 41 .44 rAA X001/001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> —I , I j�; ;-=�� SAN JOAQUIN COUNTY <br /> !fiL�� _Jj vvE'J� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-270 <br /> a 2007 Telephone:(209)468-3420 Fax: (209)464-0138 Wcb: www.sjgov.org/ d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: ,—� 'L��. <br /> ADDRESS:_ '[ <( k-n o," S,r,i A 11;4 , ac,I 1 <br /> PHONE(1)- 011Le 4V9.0 O Y_0 7t PHONE(2): n%(e �6M:� FACSIMILE' d1110 <br /> TENTATIVE'APPOINTMENT DATE: '5('2_E,7_ <br /> /0-7 Tima: L d b <br /> (Please allow 10 business days from datd of application submittal-'Tentative only-must b#confirmed) <br /> CHECK SOX TO EXPEDITE REQUEST-;85-00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � � �,��„���! DATE S I 1077 <br /> Electronic Information: Ll List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> $treat 0 Street Name City Cl Unit 1 <br /> 2. pll ' S� . - .- Ej unit <br /> Unit 3 <br /> 4. <br /> LID A <br /> l; +� Unit �\ <br /> \�\1\\\J <br /> _, ❑ <br /> Unit b <br /> 8. <br /> 9. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> 1d UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 'W SOLID WASTE FACILITY/VEHtCLE <br /> OTHER CLEANUP SITE(NON-LOP) 172 FOOD FACILITY O WASTE TIRE <br /> y�(UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL 0 DAIRY <br /> >ti+HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 1�TIERED PERMITTED FACILITY MOTEL/HOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOLISPA 0 LAND UsE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-6:OOPM - EXCLUOING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the types)of files from the Ilat above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 maxlmum 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$96.00 deposit prior to review. <br /> EHL)USE ONLY <br /> EHD 48-06 l V2008 <br />