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05/03/2005 15:13 FAX • � Q001 <br /> DATI :2ECEIVEU EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> O D ENVIRONMENTAL HEALTH DEPARTMENT <br /> ��► <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> t.1AY 0 1 7005Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> EWRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> 'R/ <br /> APPLICANT: fit BUSINESSIAGENCY: <br /> ADDRESS: L <br /> PH�.'NE(1): Z.>" 9 - _3S4 PHONE 1'2-)): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: TIS; <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIC;NATURE OF APPLICANT DATE 5 3'05 <br /> NI T DISTRIBUTION L7 Unit 1 ❑Unit 2 0 Unit 3 ❑Unit 4 ❑Unit 6 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS EH USE O Y <br /> yStreet A Street Name City <br /> *611 �f -- <br /> SUS 2 5 __ W <br /> 0 <br /> 4- Ei Corn Mararl&orbr. <br /> 5• -.00IM!M 7VI <br /> C. <br /> Mh <br /> 7. 9 <br /> 8. <br /> V PAY <br /> //yy <br /> Specific Date Range of Information Requested:From NC, to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> E!'ETHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> C UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 9 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0WASTEWATERTREATMENT PLANT ,¢ <br /> ❑TIERED PERMITTED FACILITY 0 MOTELMOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ FATTOOIBODY PIERCING 0 POOLISPA ❑LAND USE APPLICATION SITES <br /> OTHER PLEASE SPECIFY) <br /> MEDICAL WASTE FACILITY ( ) <br /> __r! L AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - E%CLUDING 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. d' <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 END 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 /> Erin se-m-aos -- <br /> 11 i-J)b <br />