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01/_.0/2006 09:49 FAX 1 209 234 7727 STOCKTON 16002 <br />01/10,12006 09:34 464013£ ENVIRONMENTAL HI _H PAGE 01 <br />UAI IVCU cnu Lvw rvurv,Dcr'� <br />SAN JOAQUI1N COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 36 Floor, Stockton, CA. 95202-2708 <br />L�I''Tclephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ebd <br />',., PUBLIC RECORDS RELEASE APPLICATION <br />APPLICk4T: 'N, L% fti,n`, -pas 1 BUSINESS/AGENCY: t kk(a- , - i d' A ss oc . <br />ADDRESS: 3410 Wr CITY � k �vY� STATF_ CA <br />PHONE (l): '13q -7-7Z2_ PHONE (2): FACSIMILE: 23LA- 7 7 27 <br />TENTATIVE" APPOINTMENT DATE: TILMO: <br />P"21111.0 Ma- <br />(Pi@aLv allow 10 business days frorn date of application submittal - "rafts dve only - must be <br />go <br />CHECK BOX TO EXPEDITE REQ 3.00 H OR CHECK ONLY) - REQUEST PROCESSED I B F <br />SIGNATURE OF APPLICANT �� /� DATE <br />Electronic 13 Ust a Map - Dewrlptlon <br />Informatlon <br />�s-EHD USEONLY <br />Unit 1 <br />■ Unit 2 <br />77 <br />0 <br />/ 5 <br />-Unit <br />Unit 6 <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) HOUSING APtATEMENT SOLID WASTE FACtLFTYNEHICLE <br />OTHER CLEANUP SITE (Non -LOP) ❑ FOOD FACILITY aWASTE TIRE <br />'Ek❑ <br />K HAZARDOUS WASTE GENERUNDERGROUND TANK (ENERATOR TCDRt(ifREMOVAL) DOG KENNEL Q DAIRY <br />❑ CHICKEN RANCH ❑ WASTEWATERTREATMEV PLAKt <br />(14 <br />I TIERED PERM11 W FACILITY ❑ MOTELIHOTEI. ❑PUMPER TRUCK/YARD"EMAL ToILFTS <br />t- PIERCMO ❑ POWSPALAND U8E APPLICATION S= <br />*_MEDICAL WASTE FACILITY 0 OYHER (PLEASE SPECFY) A,` �1 �.a 1 <br />WELL AND SEPTIC PMMrr RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00-S:OOPM - EXCLUDING HOLIDAY$. <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 64-0138 or mail to the zddress <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 (i0) 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 rile 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 />zed <br />4 aAny <br />licartt afore file lrleviews by the same applicant may require the same condition as released will be a $93,00 depositrior totrevi wthe Pense of the <br />pr <br />�JA <br />CND AA " <br />lotsinan6 <br />34 4S <br />49 <br />