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EHD LOG NUMBER <br /> SAN JOAQUM COUNTY <br /> ]ENVIRONMENTAL HEALTH DEPARTNT <br /> FEB 2 6 2007 304 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708 <br /> ENVIRONMENT FiEALfH Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PERIITISEgViGS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �� �L7d\v BUSINESSIAGENCY: <br /> ADDRESS: 2cbd <br /> I <br /> PHONE(1).q 1 L X12-�dJ7 PHONE(2) !2«-L-aS `22nt� FACSIMILE:S-50 <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 RUE -$95.00 FE=R C K QNLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> i rr <br /> SIGNATURE OF APPLICANT DATE'" � 0^�� <br /> UNIT DISTRIBUTION ❑ Unit 1. 13 Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 13 Other(electroniGlistslmaps} <br /> 'FILE ADDRESS EHD USE ONLY <br /> street# Street Name City <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. ._ <br /> d'o' <br /> 8. <br /> 9. ,.��ate.:•• <br /> Specific Date Range of Information Requested: From to :•O`: <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �RGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT "❑SOLID WASTE FACILITYIVE L�E7 <br /> R CLEANUP Srl'E(NON4-OP) E3 FOOD FACILITY 13 WASTE TIRE <br /> RGROUND TANK(MONITORINGIREMOYAL) ❑DOG KENNEL. ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMnTED FACILnY ❑MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 17 POoLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER LEASE SPECIFY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 5:00 AM-5:OOPM - EXCLUDING HOLIDAYS: <br /> 1. List up to ten addresses in the space above."Select the type(s)of files from the list alcove 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 /> y <br /> 3. A file that is actively being worked on by EHD staff may not be immediately"available for.review. A new <br /> IE 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 /> r <br /> S ti t <br /> w� <br /> END48-06! <br />{ SIV06 <br />