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May, 31. 2007 8:13AM <br />REM770 <br />MA's <br />E>;yViRQI��'A�ERVIGES BEAU" <br />APPLICANT: 1 <br />Ah anced GeoEnvironmental <br />-i No. 8774 P. 1 <br />�'. EHD LOG NumaER <br />SAN JOAQUIN COUNTY <br />EN'VfRONMENTAL,HEALTit DEPARTMENT <br />304 East 'Weber Avenue, 3Td Floor, Stockton, CA 95202-2708 ; <br />Telephone: (209) 468.3420 Fax: (209) 4640138 Web: www.sjgov.org/e <br />PUBLIC RECORDS RELEASE APPLICATION" <br />MR— D E <br />ADDRESS: 931 5 �Aw PA" <br />9USiNESSIAGENCY: <br />PHONE (1): kb� lU�fa PHONE:(2j: �"tea' $�y FACSIMILE. <br />TENTATIVE* APPOINTMENT DATE: Time: <br />Tieabe allow 10 business days from data of application submittal - "Tentative only -must be confirmed) <br />CHECK BOX TO EXPEDITE RE T - $ 4 FEE SH OR CHECK ONLY).- REQUEST PROCESSED IN.3 BUSINE5S HAYS <br />SIGNATURE OF APPLICANT _ _ DATE. —31 0-7 <br />UNIT DISTRIBUTION <br />0 Unit 1 o Unit 2 0 'Unit 3 <br />11 Unit 4 0 Unit 5 <br />13 -Unit 6 ❑ Other (electronidAistslmaps) <br />street # <br />FILE ADDRESSEHD <br />Street Name _ .. <br />City <br />USE ONLY <br />k3. <br />aGo` o <br />foo G <br />'T-Vt M <br />}rvtikbr� 4 <br />7. <br />10.':, <br />Specific Date Range of Information Requested: From _ t Q to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />it UNDERGRQUND TANK (US)) CLEANUP SITE (LOP) t] HOUSING ABATEMENT - 13 SOLD WASTE FACILITY/VEHICLE <br />❑ OTHER CLEANUP SITE (NON -LOP) In FOOD FACILITY ❑ WASTE TIRE <br />0 UNDERORDUNGTANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />gCHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATERTREATMENT PLANT <br />M TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br />TATTOOIBODY PiErtmNO ❑ POOLISPA ❑ LAND VSE APPLICATION SITES <br />MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR ROARW - MONDAY-FRIDAY3:90 AM-5:00PM - EXCLUDING HOLIDAYS. <br />I. 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 (249) 464-0138 or mall to the address <br />indicated above. Address ranges will not be accepted;- for additional assistance with file addresses, contact <br />the END, Applications received after 3:00pm 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 (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 prior to review. <br />EHD 18.02-106 <br />111IN0n <br />I (Xf4 <br />