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EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB v G 2007 304 East Weber Avenue, 3`1 Floor, Stockton, CA 95202-2708 <br /> ENVIRONMENT HEAJH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SE9VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: nti18^V BUSINESS/AGENCY: UiZal Co <br /> ADDRESS: 2� t <br /> PHONE(1)'.q(b-'(Ska-IL05--7 PHONE(2): �' ((, '�i-7Ci '�2et3 FACSIMILE:6-50 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 Abusiness from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPED $95.00 FE RCA K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2 26^O7 <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> FrJ�iND RGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILINNE LE <br /> R CLEANUP SITE(NON-LOP) 11FOOD FACILITY ❑WASTE TIRE <br /> RGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM5: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 <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 file addresses,contact <br /> the EHD. Applications received after 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 <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$95.00 deposit prior to review. <br /> —7 <br /> _rte <br /> EHD 48-06 <br /> 811106 <br />