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ivuL. VU Ve..-rrN NUI aI IUL 41b-252-8985 P.1 <br />t° SAN JOAQUIN COUNTY EHD LOG NUMBER <br />MAR.. 2 5 2008 ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />ENVIRONMENT H Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or d <br />PERry IPSERVE <br />,053 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: r t t rI BUSINESSfAGENCY: S <br />ADDRESS: /� <br />PHONE (1)-.a s02`2j PHONE (2):j�7� FACSIMILE: 14 <br />TENTATIVE' APPC3iNTMEIiT DATE: tlif 61 g , 7i, Time: AC <br />(Please allow 10 business days from of appl' tion submittal -'Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST�,VSAO FEE ASH OR K ONLY) . REQUEST PROCIESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE _&vZG Z5` <br />Electronic Information: []List ❑ Map— Description: <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />M UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOUD WASTE FACILITYIVEHICLE <br />CI OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY ❑ WAs1ETiRE <br />© UNDERGROUND TANK (MONITORING/REMOVAL) m DOG KENNEL ❑ DAIRY <br />❑ HAZARDOUS WASTE GENERATOR CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br />13 TIERED PERMn'rED FACILITY d MOTELIHOTEL 1:7 PUMPERTRucKMARDICHEM TOILETS <br />E3 TATT00/BODY PIERCING ❑ POOUSPA G3 LAND USE APPLICATION SITES <br />C,± MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM5:00PM - EXCLUDING HOLIDAYS, <br />I. 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 (2091464-0138 or mail to the address 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 fele 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 tele 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 fele reviews by the same applicant may require a $98.00 deposit prior to review. <br />EHD USE ONLY <br />