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\"� D al SAN JOAQUIN COUNTY . EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 2 G 2007 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> ENVIRONMENT HEAJH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd I J <br /> PERMIT/SE,qVICES PUBLIC RECORDS RELEASE APPLICATION <br /> tr <br /> APPLICANT: �oc1 io8kt BUSINESSIAGENCY: i_3F_S CO <br /> ADDRESS: <br /> PHONE(1):CII PHONE(2): �'l� '�j�C1'2213 FACSIMILE:S-:50 <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business Sys from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDE R UE -$95.00 FMXC R Cll K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �r DATE 2 26^O7 <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronidliststmaps) <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 /> g�� ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACIL.ITYIVE LE <br /> ���OT 1�R CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> RGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑ POOLISPA ❑ 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 AM-5:00PM - 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 /> EHD 4"6 <br /> 811106 <br />