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AP r. ��. 2005 9; 21AM A IOEO GEO �0 0 12 1 EHOP• 1NUMBER <br /> DATE P r. 11 ( //^_/ <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 107090;' <br /> AP"i 13 2005 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ERVIti �P�hEW HEALTH PUBLIC RECORDS RELEASE APPLICATION J <br /> APPLICANT[y BUSINESSIAGENCY: I(Ameeq <br /> ADDRESS: 9��Mia �"TJ p�J <br /> PHONE(1):jkg 07-16w(, PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> ,�., <br /> (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) <br /> &<HECK BOX TO EXPEDITE REQUE 3. SWVI OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINES DAYS A J <br /> SIGNATURE OF APPLICANT DATE ?. <br /> UNR 013TRIBUTION O Unit 1 nit 2 ni I@0@nit4 0 Unit 5 O Unit 6 ❑ Otho . nldllstsleko <br /> FILE ADDRESS E <br /> street Y Street Name City <br /> &: aUeS I <br /> 2. <br /> 3. - <br /> 4. 10 fittvls 6k0 <br /> 6• 7Y-JD— LODI45n <br /> 7. <br /> 8. nn <br /> 9. <br /> 19111 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 13 SOLm WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONTTORINGIREMOVAL) 11 DOG KENNEL ❑I�y.D��AIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH OCWASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOLISPA )LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AMS:OOPM - 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 /> appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address <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(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 /> 1/1&05 <br />