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Sep 01 05 OG:23p Pal-' Humphrey (559.) 226-3408 p.l <br />Sall <br />DATE IEC � EHD LAG NUMBER <br />o:L�(j��� SAN JOAQUIN COUNTY <br />tl ENVIRONMENTAL HEALTH DEPARTMENT $29 <br />d6 304 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708 <br />MAR I Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />ENVIRON_4IEN f 1(1r -q PUBLIC RECORDS RELEASE APPLICATION <br />SUSINESSIAGENCY: <br />ADDRESS: / X Q 7- 4-. L // A fb n n <br />PHONE (1)::55 - ci J 7 —I�jq/PHONE (2): FACSIMLE: <br />TENTATNE' APPow'rINm DATE: - Thm: <br />(Please allow 10 bushms days from deet of applldxdian submkW - `Tentafte only -must be Confirmed) <br />13 CHECK BOX TO EXPEDITE� "3.00 FEE OR ECK ONLY) - REQUEST PROCESSED IN 3 BUSINM; DAYS <br />SIGNATURE OF APPLICANT T ..// / DATE <br />Specific Date Range of tMiomw1lon R+equesW: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FRES <br />AS Uw x Rcwmo TAwK (UST) CmmuP SRE (LAP) 0 Housma ABATEMENT IKS&m WASTE FACIt, rdVEm ma <br />0 OTHER Ct.ump SniE (NDN -LAP) 0 F000 FACRstr 39WASTE T IRE <br /># UNDERGROUND TANK (MONfI ORtNGIRL'MOVAL) Q Doe KENNEL 0 DAIRY <br />"o HAZARDoue WASTE GENERATOR 0 CHICIMN RANCH O WAs-mm-mit TReATISF?nr PLANT <br />o MmD PERumm FA=mr 0 Moramom 0 PUNPE RTRI)CKlYARMHEM TOILM <br />0 TATrootBaW P104CM 0 POOL SPA 0 <br />0 MWCAL WASTE FAcum ;M OTHM (PLEASE <br />WELL AND SEPTIC PERMIT RECORDS ARE AyAiLAM FOR REVWN - OOo1DAY-FRIDAY 8:00 AM-li:OOPM - EXCLWM HOLIDAY'S. <br />1. List up to ten addresses in the space above. Select the type(*) of files from the list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 46441138 or mail q the adi Ess <br />indicated above. Address ranges will not be accepted —for additional assistance with file addresses, contact <br />the EHD. Applications received after 3:04 pm will be processed the next business day. <br />2. The END will notify the applicant If any EHD files exist An appointment for review will be confirmed <br />approximately tan (10) days atter receipt of application. The files will be held for a maximum of furs business <br />days for review. Appoinbaw is 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 />appl'canL Future file reviews by the same applicant may require a $93.00 deposit prim to review. <br />EHD U42 -M <br />wilts <br />VRM114A fftre3= <br />&' <br />Specific Date Range of tMiomw1lon R+equesW: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FRES <br />AS Uw x Rcwmo TAwK (UST) CmmuP SRE (LAP) 0 Housma ABATEMENT IKS&m WASTE FACIt, rdVEm ma <br />0 OTHER Ct.ump SniE (NDN -LAP) 0 F000 FACRstr 39WASTE T IRE <br /># UNDERGROUND TANK (MONfI ORtNGIRL'MOVAL) Q Doe KENNEL 0 DAIRY <br />"o HAZARDoue WASTE GENERATOR 0 CHICIMN RANCH O WAs-mm-mit TReATISF?nr PLANT <br />o MmD PERumm FA=mr 0 Moramom 0 PUNPE RTRI)CKlYARMHEM TOILM <br />0 TATrootBaW P104CM 0 POOL SPA 0 <br />0 MWCAL WASTE FAcum ;M OTHM (PLEASE <br />WELL AND SEPTIC PERMIT RECORDS ARE AyAiLAM FOR REVWN - OOo1DAY-FRIDAY 8:00 AM-li:OOPM - EXCLWM HOLIDAY'S. <br />1. List up to ten addresses in the space above. Select the type(*) of files from the list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 46441138 or mail q the adi Ess <br />indicated above. Address ranges will not be accepted —for additional assistance with file addresses, contact <br />the EHD. Applications received after 3:04 pm will be processed the next business day. <br />2. The END will notify the applicant If any EHD files exist An appointment for review will be confirmed <br />approximately tan (10) days atter receipt of application. The files will be held for a maximum of furs business <br />days for review. Appoinbaw is 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 />appl'canL Future file reviews by the same applicant may require a $93.00 deposit prim to review. <br />EHD U42 -M <br />wilts <br />