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Feb 02 05 12:42p Scrtt Pritchard 858-874-1982 <br />e <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY <br />h v ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />9, ?095 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: ,vN"v.Sjgov.org/ehd <br />I <br />ENVInOPINich1T HLTH <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: a 60 l/ r� % ry-c. rc. <br />ADDRESS: /J�� G:16,ak !�r iCc C-�•,a G}i 9Z//l <br />N <br />BUSINESS/AGENCY: --rvx <br />p.1 <br />tY1U LULi NUIVlbtK <br />PHO �JE (1): %Y-�g�'� PHONE (2):_b-/ Y ! S S// 0 FACSIMILE: <br />I <br />�p�`' TENTATIVE' APPOINTMENT DATE: Time: <br />U (Please allow 10 business days from date of application submittal - "Tentative only - must be confirmed <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 F CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />' SIGNATURE OF APPLICANT s// DATE <br />UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit Unit nit 4 O Unit 5 ❑ Unit 6 10 Other (electronic/]ists/maps) <br />_ Stret NameFILE ADDRE EHD USE ONLY <br />Street # e_ _ City <br />I�tv/USl' 1. AEi r. G ir1 �r kfo l..--- <br />rij <br />E -M 12" <br />I MW <br />UP ,C <br />tnu qts -02-006 <br />11/23104 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />X <br />!a+ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ <br />FOOD FACILITY ❑ WASTE TIRE <br />'UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT,:i <br />❑ TIERED PERMITTED FACILITY IDMOTEUHOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />r <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 />" <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />! <br />indicated above. Address ranges will not be accepted —for additional assistance with file addresses, contact <br />the EHD. <br />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 />�ti <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 $93.00 deposit to <br />prior review. <br />tnu qts -02-006 <br />11/23104 <br />