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i: rlrm AO'4nced GeoEnvirOnmenfal <br /> DATE RECEIIV�EID��'� V.01 No. 3796 P. l <br /> WOWED LTJ SAN JOAQUIN COUNTY EHD LOG NUMB" <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 601 UGt, 0 9 2008 Telephone: (209)468-3420 Fax: (208)464-0138 W bMain Street Stockton, CA 2 www.S1sov,or d <br /> ENVIRONMENT HEALTH PUBLIC RECORDS �? <br /> PE RELEASE APPLICATION '3 <br /> APPLICANT: rC <br /> ADDRESS; ,.a BUSINESS/AGENCY: <br /> PHONE(1): SZJ^I`aS0/ r City/State2lp <br /> PHONE(2)1'L4 6S� <br /> TENTATIVE*APPOINTMENT DATE; —FACSIMILE: <br /> (please allow 10 business days fromdata of applicatlnn aubmhtal-• Time <br /> -i <br /> CHECK BOX TO EXPEDITE RE�p[�,l/GST -115 FEE SH OR HECK ONLY) Tentative only-must be confirmed) <br /> SIGNATURE OF APPLICANT �l J REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE /2 - <br /> Electronic <br /> Z ^Electronic information: ❑ List[]Map—Description: <br /> _ FILE ADDRESS AL <br /> Street NEHD.USE ONLY <br /> .,_. �Streat Name Cit <br /> 1. '1 IAL. ❑ Unit t <br /> 2. .. <br /> El unit 2 <br /> 3. <br /> 9 _ _ .yam . <br /> 4. ` qL • ( CA 39 Unit 3 <br /> 6. p Sr <br /> 6 Unit 4 <br /> 7. <br /> 8. __.. ...... .... nit 5 <br /> ❑ units <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> f�uo�NIDERUROVND <br /> OERGROUND TANK(UST)CLEANUP$ITE(LOP) L4 HOUSING ABATEMENT 173 SOLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILIY 0WASTE TIRE <br /> TANK(MONITORINGIREMOVAL) 1:1 DOG KENNEL 0 DAIRY <br /> 0 HA1AR000S WASTE GENERATOR 13 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY C]MOTEL/HOTEL ❑PUMPER TRUOK/YARDICHEM TOILETS <br /> •TATTOOBODY PIERCING 0 POOL/SPA <br /> 0 MDCAL WASTE FACILITY F )THER(PLEASE SPECI1Y)AII.9-- LLW&CNSSX <br /> WELL AND SEPTIC PERMIT REbORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-S:OOPM -ECGLUMNG 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 mall to the address indicated above. Address <br /> ranges will not be accepted–for additional assistance with file addresses,contact the EHD. Applications recelved 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$106 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-08 8/04108 PUBLIC RECORDS RELEASE APP PORM <br />