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05/03/2005 15:13 FAX • • Q001 <br /> EHD LOG NUMBER <br /> DAI I RECEIVED ,SAN JOAQUIN COUNTY <br /> v ENVIRONMENTAL HEALTH DEPARTMENT <br /> 174��o <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 <br /> =7,AY 0 1 ?005Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> EIMRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ant Nr �l�yi rnt't <br /> APPLICANT:11 BUSINESS/AGENCY: Lr11Ci <br /> ADDRESS: L <br /> PHk_,NE(1): )4 PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 Business days from date of application submittal-'Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIC,NATURE OF APPLICANT (�C� p� Grr� 1c- DATE 5 " '05 <br /> UNI T DISTRIBUTION ❑ Unit 1 13 Unit 2 ❑Unit 3 ❑Unit 4 ❑Unit 5 <br /> Eu <br /> FILE <br /> 6 13 Other(electronidlistslmaps) 2 <br /> l!�® FILE ADDRESS EHU USE ONLY <br /> y Street-9— Street Name City <br /> �v S 2 _. v.1tenA <br /> 1 3. Oct i a <br /> 4. E i. Car Q <br /> 7( <br /> 6. ij <br /> 7 --- <br /> 8 - <br /> 9. <br /> 10. _ //�� <br /> Specific Date Range of Information Requested:From JN5I to —fir <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> G!�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 11 SOLID WASTE FACILITYNEHICLE <br /> 10!:•THER CLEANUP SITE(NON-LOP) <br /> ❑FOOD FACILITY ❑WASTE TIRE <br /> EI UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑jJAIRY <br /> 0 HAZARDOUS WASTE GENERATOR M CHICKEN RANCH 0WASTEWATERTREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ rATTOo(BODY PIERCING ❑POM/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) _ - <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 /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 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. r` f <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 /> ELIC)48-04.006 <br /> 11 -.136 <br />