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/02/2008 10: 17 FAY, <br /> Z001/001 <br /> V <br /> EHD LOG NUMBER <br /> SAN,1QAGtUiN COUNTY <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> OCT 2 2008 600 East Maln Street, Stockton, CA 96202-3029 <br /> Telephone; (209)468-3420 Fax. (209)464-0138 Web., www,sjgov.org/ehd <br /> E( VIFON[VIIEiNT NENLT ? <br /> p �( IMSER,VICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: City/Statemp 1f' <br /> PHONE(1): '"►/� PHONE(2) r %69 FACSIMILE: <br /> 0 1A Iq a <br /> TENTATIVE"APPOINTMENT DAT Time, <br /> (Please allow 10 business day fro date of apps tlon submittal-'Tentative only-must b confirmed) <br /> 0 CHECK BOX TO EXPEDITER QU OS FEE CAS R ONLY)-REQUEST PROCESSED IN,3�BU}SIN S DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: Q List Map•-Descrlpt on; rr <br /> FILE ADDRESS EHD USE ONLY <br /> Sfr®at# Street Name cityIt 1 <br /> 1. CX <br /> 0 , ay <br /> n Iv\Pan <br /> U (, I Iv.)I 0 /J0600 Unit 2 <br /> 4. No t ln'1 f 3c►ij 1N0C�/� u►ilit;� ' <br /> 5 ,� <br /> 6.A �'(��1 oES,AVU � unit 4 <br /> T. 1 0 , <br /> $ � 'RALv � Unit S <br /> 5 , Fi��,(0/� <br /> tJ UStc 9. t U0-r t+vi, 66-s N0 co Unit <br /> Uod <br /> Specific Date Range of Information Requested:From to e <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES T6'(—C. k�— <br /> pppLl veRGRoUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT LID WASTE FACILITYIVEHICLE <br /> HER CLEANUP SITE(NON-LOP) /� 0 FOOD FACILITY TE TIRE <br /> tNAZARDOUS <br /> DERGROUND TANK(MONITORINGIREMOVAQ) - 13DOG KENNEL AIRY �� �WASTE GENERATOROC d CHICKEN RANCH STEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY El MoreLIHOTEL MPER TRUCK/YARDICHEM TOILETS <br /> ❑TAT1no/BoDT PIERCING ❑POOLISPA NO USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 3:00 AM-6:00PM -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 appropriate <br /> box(es)- At least one file type MUST be selected_ Fax to f2091444-0128 or mail to thea dress indicated above. Address <br /> ranges will not be accepted -for additional assistance with file addresses,contact the EHD. Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> 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 applicant. <br /> Future file reviews by the same applicant may require a$106 deposit prior to review. <br /> EHD USE ONLY <br /> D c <br /> EHD 43-06 3/04100 PU$LIC RECORDS RELEASE APP FORM <br />