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05/10/2008 09:54 916446"'93 MATT PAGE 01 <br /> DATER CEIVED EHD LOG NUMBER <br /> SAN JoAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT r,. ' <br /> r <br /> 600 East Main Street, Stockton, CA 95202-3029 - 'I r <br /> !�LC-� <br /> Telephone: (209)468-3420 Fax: (209)464-0136 Web: www.sjgov.org/e d <br /> Fv!A,;( A Cl'li <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �jQ77- BUSINESS/AGENCY: D�L--nq <br /> ADDRE=SS: X27-'E' W6_1 C-,,? ! ) elf <br /> PHONE(1): q/L C+�,L 3eO3 PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: S Z q tl' Time: R^1 <br /> (Plesso allow ten business days from date of application submittal--Tentative only-must be conflrmed} <br /> © CHECK BOX TO EXPEDITE REQUEST-$99 00 FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 02? <br /> Electronic Information: 0 List 0 Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> V7. <br /> Street Name City 0 Unit 1 <br /> W i 1wSoN (�flY 5 _ 5 T`Out-mnJ �t ,t <br /> (� Yo S fIT� 6VEs'uC "ANSc,9 t.d r t' �P KTounit 2 <br /> -- ---(_H,1e71W W;gYr 5�C�a0 i� :r ? e5 011 <br /> W-4�Lo0 �� 5 UClc—(OJ - ,C�e'.S,Y09PA/t�a7(� 10 <br /> nit4 <br /> ✓_(D H( J, tf9 t�"Iy illy 0 units <br /> ...e � <br /> 10, units <br /> Specific Date Range of Information Requested:From /9�(� to A P/2e56'1; <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILITY(VEMCLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE '�nI <br /> X UNOERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY `'(J I <br /> KHAZAROOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ,E TIERED PERMITTED FACILITY ❑MoTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 0 POOLI$PA M LAND USE APPLICATIONIT^Es <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY)61'r/lyr-t t�L-67VD T O 7( 7 r ,, C <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REvItw -MONDAY-FRIDAY 8:00 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(209)464-0138 or mail to the above address. Address ranges will <br /> not be accepted-for additlonal assistance with file addresses,contact the EHD_ Applications received after 3.00 pm will <br /> 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 <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 the EHD staff may not be Immediately available for review. A new 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> use WW <br /> EHD 46-DE 10129W PUBLIC RECORDS RELEASE APP FORM <br />