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DATE RECEIVED •SAN.TOAQUIN COUNTY EHD LOG NUMBER <br /> 4,0�'%' y(I L�l� ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP r 1006 pho East Weber Avenue, 3rd Floor, Stockton, : ww.sjg v.or L5 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: v✓wwsjgov.org/ehd <br /> ENv1r�IoNML"'11T HEALTH <br /> FgMj'jj SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��/`�<- —CQF2 BUSINES /AGENCY: <br /> ADDRESS: yg�n Pc-;+-ef1 .+tom <br /> PHONE(1): 09SZ PHONE(2): L FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 busines s from date of application submittal-`Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE -S -$ 0 F (C K ONLY)-REQUEST PROCESSED IN 3 BU INE S DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronicllistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. <br /> __qF0 CO �/aSEaczTE tu,,./tca u�,,yec� <br /> 2. 9533 <br /> 3. <br /> 4. <br /> 6. v <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Tffi UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY ❑WASTE TIRE <br /> A UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> .❑TATTOO/BODY PIERCING ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 <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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> 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 /> EHD 48-06 <br /> 8/1/06 <br />