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FEB-4-2010 11:47A FROM:GEOPHASWV 2095690295 T 40138 P.2 <br /> Un[D �( � �� SAN JOAQUIN COUNTY G NUMBER <br /> W lei ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 0 4 2010 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION _ / <br /> PER A'TAPPLICANT:' p a, er BUSINESS/AGENCY: 'Wa n Avo V WW � Tr) <br /> ADDRESS: ►Zc/y�37 �P'4C p•14M /74L City/State/Zip 7 <br /> PHONE(1l: 'l'�7 d�Q3 — PHONE(2): FACSIMILE:-5769 0�9J <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (PleasD allow 10 business days from date of application submittal-Tentative only-moat be Conn rmyd),' .' •,• .' <br /> CHECK BOX TO EXPEDITE REQUEST•$105 FEE CASH OR CHECK ON Y)-REQUEST PROCESSED IN 3 BUSINE <br /> SIGNATURE OF APPLICANT�/�i DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> re <br /> StreetN Stet Name <br /> city <br /> -- ------ ❑ Unit 1 <br /> 2. <br /> OO W /11 ❑ Unn2 <br /> 3. <br /> 4. <br /> nit4 <br /> T• ':` Ai� Unit6 <br /> 8: <br /> 9. Units <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> SCJ NDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT Cl SOLID WASTE FACILITYNEHICLE <br /> AGI OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> IPJ UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> •HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY O MOTELMOTEL C!PUMPER TRUCKP'ARO/CHEM TOILETS <br /> 0 TATTOO/BDDY PIERCING 0 POOL/SPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-6:OOPM - EXCLUMNG HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the typo(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 12091464-0138 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 tiles 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 48-06 6/09/08 PUBLIC RECORDS RELEASE APP FORM <br />