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Dec. 8. 2005 2:28PM anced GeoEnvironmental No. 3195 P. 1 T <br /> SAN JOAQI(JTN COUNTY EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT / <br /> DEC - G 2005 304 Fast Weber Avenue,3'Floor, Stockton,CA 95202-2708 119�TH Telepbone:(209)468-3420 Fax:(209)464-0138 Web;www.sjgov.or&hd <br /> ENVIR <br /> PCR LT,!aEFi�fC S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Suzanne Henderson BUSINESSIAGENCY: Ad Vented Ge n m I <br /> ADDRESS: 837 Shaw Road Stockton CA 95215 <br /> PHONE(1): 209-467-1006 PHONE(2): Cell;209-712-2278 FACSIMILE: 209-467-1118 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 buslnoss days from data of application 6 jornMal--Tsnwa —*OMrmed)y-must be COnn �.� <br /> CHECK BOX TO EXPEDITE RE T-$93.00 FEE( H OR ECK ONLY)-REQUEST PROCESSED IN 9 BU INE DAYS <br /> SIGNATURE OF APPLICANT F.. DATE 9oZ <br /> UNIT DISTRIBU710N O Unit1 Aunit2 Unita nIt4 0 Units ❑ Units lkher(e lectronionieta/mepe) � <br /> FILE ADDRESS Q <br /> Street# Straw Name City EHD USE ONL <br /> z, 3 \ <br /> 3. Z <br /> 4. c � <br /> 6. C _ <br /> m <br /> 6. u to <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 110 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT �SOLIDWAS7E FACNTYNEHICLE <br /> W OTHER CLEANUP SITE/(yNON-LOP) OFOOD FACNTY 0SOLIDWI� <br /> M UNDERGROUND WASTE <br /> TANGENERATOR <br /> N 4REMOVAL) O DOG KENNEL ❑DAIRY <br /> WAsTz <br /> El HARED PERMITTED <br /> TIED FACILITY DR 13 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED TATTWBoDy P1E FACILITY 0 MOTEUHOTEL t7 PUMPER TRUWYARO/CHEM TOILETS <br /> 0 MEDICAL WASTE <br /> 0P000SPA 0 LAND USE APPLICAToN SITE$ <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-$:DDPM - EXCLUMNG HOUDAYs. <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)454-0138 or mail to the address <br /> (ndlcated 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 /> appllCation 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 /> ENDO 2406 <br /> TNY06 <br />