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dA4u,gTµ3 2UUl__h:33NM Advanced beotnv ronmenTal rD. n/u_Hc; ;,UMBER <br /> SAN JOAQUIN COUNTY V <br /> L`N'OvAONMENTAL HEALTH DEPARTMNef <br /> 1 600 East Main Street, Stockton, CA 95202 O <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov. <br /> 5 7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: kr-, Ake BUSINESS <br /> IAGENCY: AG e <br /> ADDRESS: ry�D^/ 9-1 f(A 6S•2 1S <br /> PHONE(1):209 GOi 3.541 PHONE(2): d0 <br /> 4(.7 /004 FACSIMILE;o�0k cf(v-? ( 118 <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> 171 CHECK BOX'to EXPEDITE R _$9 <br /> FEE CASH OR C ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE " <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS_. EHD USE ONLY <br /> Street I1 SSt�re)ett Name City ❑ Unit 1 <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4. - _ Unit 3 <br /> 5. <br /> 6 _ Unit 4 <br /> 7. <br /> unit 5 <br /> 8. <br /> FO <br /> Speclfic Date Range of Information Requested:From ��gs _ to prwts'f <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Pf4iINDERGROUND TANK(UST)CLEANUP SITE(LOP) 71 HOUSING ABATEMENT ❑SOLID WASTE FACIunNEHICLE <br /> ❑ OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY ❑WASTE TIRE <br /> 4XJUNDERGROUND TANK(MONITORINGIREMOVAL) MDOG KENNEL ODAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTEL/HOTEL I7 PUMPER TRUCK/YARb/CHEM TOILETS <br /> TATTOO/BODY PIERCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY III,OTHER(PLEASE SPECIFYJ[�T &(r�J I)f.,h de, qy -1196 <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(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464-0138 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 behold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly- <br /> 3. A Tile 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$95.00 deposit priorto review. <br /> EHD USE ONLY <br /> EHD48-66 51182007 <br />