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02/13f2006 10:32 sax1a 0o21ooz <br />DATE, RECEIVEis 40 SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL REALTH DEPARTMENT <br />304 East Weber Avenue, 3`1 Floor, Stockton, CA 95202-2708 <br />Telephone: (204) 468-3420 Fax: (209) 464-0136 Web, www.sjgov.org/ohd <br />PUBLIC RECORDS RELEASE APPLICATION 7 <br />APPLICANT: � BUSIHESSIAGENCY: k <br />ADDRESS• Zr ❑ r, . /�2 `� i (..� S f CITY_ L C 57ATE- � <br />PHONE (1): 7 1- J,I���") PHONE (2): FAC-SIMILEY L J <br />TENTATIVE` APPotKTmr=NT DATE: 7,/2,:7 /12L, _ Time: <br />(Please allow 10 business dap from date of applCcMon cubmltfai - •Tental[ve only - Bust be confirmod) <br />❑ CHECK BOK TO EXPEDITE R€4 5T - 83,0 FE {CAS 012 CHECK ONLY) - REQUEST PROCESSED IN S BUSMEE S DAYS <br />SIGNATURE OF APPLICANT DATE l)G <br />Electronic <br />information <br />❑ List CO Map - Description - - i <br />FILE ADDRESS EHD USE ONLY <br />str.at # Street Nance CRY <br />.Zr <br />® Unit 1 <br />2. Tom' <br />3. r -Unit <br />2 <br />4. <br />g Unit 3 <br />G_ - A'Po S_- <br />7. <br />Unit 4 <br />e' <br />O Unit 5 <br />s. <br />�. <br />El Unit <br />Specific Date lunge of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />1NOERGROUND TAw (UST) CLEANUP SITE (LOP) 11Housm i AHATEmrN-r CJ SOLID wA$TE FACILITY1VEmc4E <br />TNER CLEANUP SITE (NON -Ll7P) ❑FOOD FACI11fiY ❑WASTE TIRE <br />UHNDERGROUND TALK (MONITORINWMMOYE <br />AL) la DOG KEL CpaIftY <br />A2ARbouS WA -9T7 GENERATOR Q Cxrc�mN RANc}I WASTEWATER TREATMENT PUNT <br />❑ TIEgw PffA(rT rED FACILITY O MOTELIHOTEL ❑ PumpF_R TRUCKNARu/CHEWAI. TOILET$ <br />G TATTuoi 300Y PIERCING L7 POOUSPA LAND Use ApnicATIOM SrEge <br />13 MumAL WAsTe FACILITY ❑ OTHER (PLEASE SPECIFY) — WELL AND SEPTIC PERNSlT RECORDS ARE AVAK ABLE FOR RMEW - MQNt)AY-FRIDAY 0:00 Am -5,0" - EXCL=KG HOUDATS.. <br />1, L.Ist 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) 484-0135 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 prat will be processed the next business day. <br />2, The EHD will notify tho 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 hold for a maximum of five business <br />days for review. Appointments should be scheduled accordingly. <br />3. A file that is actively being worked nn by EHD staff may not be Immediately available for review, A new <br />application may be submitted when the flie 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 re-qulre a $93.00 deposit prior to review. <br />EWD 4546 <br />fun1f2ws <br />