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10/23/2007 e9:23 2133BOF--q5 ENVIRONMENTAL PAGE oi/ei <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTV <br /> ENVIRONMENTAL HEALTH MI'ARTMEN <br /> rd <br /> Avenue,3 Floor, Stockton, CA 952 <br /> 304 East Webiir <br /> o3� g <br /> (209)464-0138 Web: www. <br /> Telephone.(209)468-3420 Fax. /ld773 <br /> j <br /> PUBLIC CORDS RELEASE APPLICATION <br /> APPLICANT: r cr\ 13USINESSfAGENCY: <br /> ADDRESS: <br /> PHONE(2): FACSIMILE: LEO-0,50,5 <br /> TENTATIVE*APPOINTMENT DATE- Time; <br /> (Please allow 70 business clays from(late of application submittal-*Tantafivo only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REOU ST-$95.00 FF_E(CASH R C ECK ONLY),REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �L_Q hlf Q <br /> Electronic Information: 0 List E)Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street» Street Name 0 unit I <br /> 1. <br /> 2. Unit2 <br /> 3. <br /> 4. Unit S <br /> G. <br /> UnIt4 <br /> 6. <br /> Q Units <br /> Unit 9 <br /> 110. <br /> Specific Date Range of information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Uri DFRGRaurm TAN K JUST)CLEANUP SITE(LOP) F-1 HOUSING ABATEMENT D SOLTOWAsTE FACILITY/VEHICLE <br /> orHPR CLEANUP SITE(NON-LOP) 0 FooD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MoNrToRiNc,1REM0VAL) 13 DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH CI WASTEWATER TREATMENT PLANT <br /> Tmnev PERMITTED FACILITY MOTEL/HOTEL PUMPER TRVCWYARDfCHEM TOILETC <br /> TATrooMoDy PIERCING ❑PCIOUSPA Q LAND USE APPLxA-noN SITES <br /> MEDICAL WASTE FAciLrry C.t OTHER(PLEASE SPECIFY) <br /> LL AND SEPTIC PERM[TRECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8.00 AM-5:00P?A - EXCLUDING HOLIDAYS, <br /> List up to ton addresses in the space above. Select the type(s)of files from the list above by chocking the 2pproprLati, <br /> box(es). At least one file type MUST be selected. Fax to(209)4134-01136 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications rnelyed after <br /> 3,00 pm will be processed the next business 6y, <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 hold 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 now 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 /> EHO 4M8 0/11312006 <br />