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Nov. 5, 2008 10: 34AM AJ ced 1al No, 3530 P. 1 <br /> DATE Mr-ULIVE:U EHD LOG NUMBER <br /> a,\ SAN J(,1 N C OC7NTY <br /> e `( ' <br /> �NVIRONMENTAL 1AALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 IFC 6 <br /> a <br /> Telephone:! one; (20.) 408-3420 FtZx;;(209)464-0138 V1 eb; w�vw.Sj�ov.org/ei1c1 <br /> PUBLIC RECORDS RELEASE APPLICATION _ <br /> r S AI}�1&"NT:_ M1V C01(1LV)T0.- _BUSINESSIAGENCY: (VaAcrd C-�roEnviron►>rt�h�a <br /> f <br /> C::) Ates: $3 �tiaw Rd�d ��+o 5 yf 5 <br /> PHONE(2): FACSIMILE: <br /> r=' :Z 4 TENTATIVE*APPOINTMENT DATE: _ Time: <br /> O A—A <br /> ,r .��P{ a allow 10 business days f��rmdate of applicatlOn submittal-*Tentative only-must be confirmed) <br /> A CHECK BOXTEXPEDITE REQUE S9e QDEE( OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> $IAPPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS _ _ _EHD USE ONLY <br /> Street.,# Street Name i City <br /> —_ .—.. -- ❑ Unit 1 <br /> 1. 2 3�. ._ <br /> 2. J$gyp I D unit 2 <br /> 4. t, .1Q �i0r{�1? Unit3 <br /> — — <br /> 6 Unit 4 <br /> $' I ❑ Unit 5 <br /> —. . <br /> C] unit s <br /> Specific Date Range of Information Requested: From to <br /> tu <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NQERGROUND TANK(UST)CI.E11ANUP SITE(LOP) HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> THER CLEANUP SITE(NON-LOP) 11FOOD FACILITY EIWASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY M MOTELIHOTEL ❑ PUMPER TxucKIYARDICHEM TOILETS <br /> TAT700/B00Y PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 17 OTHER(PLEASE SPECIFY). <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPm - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies 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 pin 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 file 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$98.00 deposit prior to review, <br /> EHD USE ONLY <br /> EHD 49-06 WEB 6/912007 <br />