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02/16/2006 16:05 FAX X1002/002 <br /> ©ATE RECEIVED <br /> SAN JoAaUnv COuCOUNTYEHE,LOG NUM6ER <br /> Evvm0NmENTAL,HEALTH DEPARTMfENT <br /> 304 Fast Weber Avenue, 3rd Floor, Stockton; CA 95202-2708 <br /> Telephone.(209)468-3420 Fax: (209)4644138 Web: www.sigov.org/ehd <br /> 2006 FEB 16 N► 4: 18 Zz2yt <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIc�t�r.a iT t�4 M BUSINESSiAGENCY• K_LC_cfi�C-�Y <br /> �CI7YSTATE <br /> ���,\ <br /> PHONE 1 ��/ — x:. <br /> ( k 4� R`fff 13`1S ,_PHONE(2): FACSrmILE• - <br /> TENTATIVE`APPOINTMf:NT DATE: � o�-?J Time: . <br /> (Please allow 10 buslness days from date app kation submi tal-*T6r b6ve oniy-must be confirmed) „ <br /> CHECK BOX TO EXPEDITE REQUE T-$93.00 E(GASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic ❑ List 13M <br /> Information aP-Description <br /> FILE ADDRESS <br /> street if Street Name city EHD USE ONLY <br /> Unit 1 <br /> , 2. 9 y <br /> 3' S <br /> XUn4. lt 2 <br /> YUnit 3 2/Z 7- <br /> 6. <br /> z. .� Unit 4 <br /> $ 0'` Z` O Unit 5 <br /> 9. <br /> 90. Unit 6 <br /> Spec date Range of Information Requested; From to <br /> _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES A <br /> UNDERGROUND TANK(UST)CLEANUP Srm(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY a <br /> OTHER CLEANUP SrtE(NDN-LOP) ❑ FOOD FACIIJTY E]WASTE TRE 4 <br /> UNDERGROUND TANK(M QNnDRI"WREMOVAL) ❑ DOG KENNEL 1K DAIRY <br /> •HAZARDOUS WAs7E GENERATOR O CHICKEN RANCH 181 WASTEWATER TREATMENT PLANT <br /> 13 TIEREb PE1WTTED FACILITY E7 MOTELIHOTEL O PUMMR TRUCKiYARDICHEMIOAL.TOILE <br /> ❑TATTOWBODY PIERCING ❑POOL/SPA ❑LAND UsE APPuCATlon SITES <br /> ❑MEDICAL WASTE FACILITY C7 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAII-1gLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-6:0DPM - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with fila addresses,contact <br /> the END.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD flles exist. An appointment for review will be confirmed <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93,00 deposit prior to review, <br /> CHO 4"S <br /> 70!712006 <br />