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11/25/2UUU 1J:5( FAX 001/001 <br /> DATE RECEIVED <br /> -c SAN JOAQUIN COUNTY - EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone. (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/eAd // <br /> PUBLIC RECORDS RELEASE PPLICATION �f <br /> APPLICANT: BUSINESS/AGENCY: _ �'1P►'T'r�lh )t <br /> ADDRESS: p Q-kin, n Clty/state/Zlp <br /> b. /! ( <br /> PHONE(1): 'YDV:Q�� PHONE(2): ` FACSIMILE: _ <br /> TENTATIVE"APPOINTMENT DATE: Time: I I �F.t!`-`t <br /> (Please allow 10 business days from date Or application submittal-"Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE RE T-$V5 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS AYS <br /> SIGNATURE OF APPLICANT DATE ` 11 <br /> Electronic Information: ❑ List [] Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> * Street Name �-{� City <br /> 1. N r c�UC���n U 1 <br /> 2. 1--3 J o2 �o Unit 2 <br /> 3. �q v �'4 <br /> 4 ��5 N . El rcxdla Unita <br /> s. <br /> 100 <br /> s. /' Unit 4 <br /> 7. t, 5 <br /> S. <br /> 9. <br /> 10 - Unit 6 <br /> Specific Date Range of Information Requested: From fCr to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNbERbRAUND TANK(UST)CLEANUP SITE(LOP) HOU87'ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY WASTE TwrF <br /> UNDF-ROROUND TANK(MONITORINa/REMOVAL) DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATORCHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MO7EUHOTEL PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATT"BODY PIERCING OOUSPA //�� 1-5 D USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)_ AU I Tl S <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAIL"LE FOR REyIEw - MONDAY-FRIDAY 8;00 AM-3:OOPM - 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 fele 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 4"6 8104/08 PLIM V'RFrORDS RFI FARF APP FORM <br />