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�1��EEHD LOG NUMBER <br /> QD SANJOAQUINCOUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB v 6 2007 304 East Weber Avenue, 3'd Floor, Stiockton, CA 95202-2708 <br /> ENVIRONMENT HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/chd1 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �� lflp 11 BUSINESSIAGENCY: +- <br /> ADDRESS: 11 d 1 <br /> PHONE(1):�Q,.-R�X2-aQ5� PHONE(2): �l6-k7gI `224Ck:3 FACSIMILE:�✓� ` " <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business ays from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPED E R UE -;195.00 FE R C K ONLY)-REQUEST PROCESSED IN 33 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l! DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 © Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/ma <br /> FILE ADDRESS EHD USE ONLY <br /> Street of Street Name City <br /> F2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. �_. .. <br /> Specific Date Range of Information R } <br /> g Requested: From to <br /> ENVIRONMENTAL HEALTH Dt;PARTMENT FILES <br /> �0= <br /> � RGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 'r7 SOLID WASTE FACILnYIVE LE' <br /> FR CLEANUP SITE(NON-LOP) Ci FOOD FACILITY C3 WASTE TIRE <br /> RGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL 0 DAIRY <br /> RDOUS WASTE GENERATOR ❑CHICKEN RANCH d WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRucKIYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA 0 LAND USE APPLICATION SrrEs <br /> ❑MEDICAL WASTE FACILITY L7 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('$)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 reg6ire a$95.00 deposit prior to review. <br /> EHD 4806 <br /> 811106 <br />