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MAY-31-2008 0148 AM P. 1 <br /> DATE RECEIVEnEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 f=ax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: - y— e BUSINSSSiC'ENCY): IV'-yQe <br /> ADDRESS: G Cy i �I 't <br /> ?tn q3 <br /> PHONE(1):. PHONE(2): FACSIMILE:/ <br /> TENTATIVE"APPOINTMENT DATE: j Time: ( � C) 171 <br /> (Please allow ton buslneee days from date(Of applie#on submittal-•rentW"only-must ba confirmed) <br /> I CHECK BOX TO EXPEDITE RISQUE 00 F E(CASH A C K ONLY •REQUEST PROCESSED IN THREE USIN S DAYS <br /> SIGNATURE OF APPLICANT DATEC� <br /> Electronic information., [ILlat❑Map-Desoriptlon: -- <br /> FILE ADDR98$ EHD U$E ONLY <br /> stn>et Street Name city o unit 1 <br /> 2. <br /> ❑unit 2 <br /> f <br /> 8. <br /> 4, unit <br /> 5. <br /> g, unit a <br /> 7. <br /> $, <br /> Unit 5 <br /> 9, <br /> L10- <br /> Specific Date Range of information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> t <br /> RGROUNo TANK(UST)CLEANUP SITE(LOP) �OUSING ABATEMENT (D SOLID WArrE FACILITYIVEHICLE <br /> R CLEANUP SITE(NON-LOP) rl FOOD FACILITY ❑WASTETIRE <br /> RGROUND TANK(MONITORING/REMOVAL) )UOO KENNEL ©DAIKY <br /> RDOU$WASTE GENERATOR ❑CHICKEN RANCH ❑WAsTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTCL/HOTEL D PUMPER TRUCKIYARD/CHEM TOILETS <br /> 0 TATTo0190DY PIERCING ❑POOL/SPA P%�I.AND BP APPLICATION®,I <br /> 0 MEDICAL WASTE PACILITY )I 0PTHRR(PLEASE SPECIFY) I YIg C7• l Lk) V t? � q Yy?� ( I <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE POR REVIEW -MONbAY-FRIDAY 8t00 AM-8,000m - SxtWD Q HOUDAQ. <br /> 1- List up to ten addressee In the space above. Select the type($)of flies from the list above by checking the appropriate <br /> box(se). At least one file type MUST be selected. Fax to(209)484.0158 or Mail jg t(lit AAg n iiggr!3gs. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 5:00 pm will <br /> be processed the next business day. <br /> 2, The EHD will notify the applicant If any SHO files exist. An appointment for review will be Confirmed approximately ten <br /> days after receipt of application, The flies 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 the EHD staff may not be immediately available for review. A now application <br /> 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 applicant, <br /> Future file reviews by the same applicant may require a;99.00 deposit prior to review. <br /> EHD USE ONLY <br /> e —PER—UG RaCORD3 r1aLRUH APP RM— <br />