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03/22/2005 15:45 17078773 ANTON • PAGE 01/0 <br /> EHD LOG NUMBER <br /> �I PATE RECEIVED SAN JOAQUIN COUNTY /'� <br /> �41 ENVIRONMENTAL HEALTH DEPARTMENT f <br /> 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 ( 1 111 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web: www.Sjgov.o1WflAR 22 PN 3"553 - <br /> PUBLIC RECORDS RELEASE APPLICATIONAN JOAQUIN COUNTY <br /> APPLICANT: /�D SUSINESSIAGENCY: <br /> ADDRESS: �}.• O 77-K0; 7-EL -7 32—p-7�7� <br /> PHONE(7):,LD b 6-� PHONE 121:1��g-77 - L$ FACSIMILE: 707 �f —,�2 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date 0 ppllcabon submittal--Tentative only-must be confl mod) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST EE OR CHECK ONLY)-REQUEST PROCESSED IN 3 USIN S DAYS <br /> SIGNATURE OF APPLICANT DATE 3 2zD r <br /> UNI' DISTRIBUTION ❑unit 1 ❑ Unit 2 = x]d4 nitd DUnit 6 Unit ❑ Other(eledroniGliefslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> street R Street Name City <br /> 1. AJC <br /> 2. EST AjF- TorKry Hn0 S <br /> 3.6. <br /> , < <br /> 4. <br /> 7. <br /> 8. <br /> 9. �t <br /> _ <br /> Spaciflic Date Range of Information Requested:From tc �Ii�Nll <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑SOCIO WASTE FACLITYNEHICLE <br /> UNDERGROUNO TANK(U$T)CLEANUP SITE(LOP) O HOUSING ABATEMENT <br /> WOTHERCLEANUP SITE(NOwLOP) 13 FOOD FACILITY 0wARY TIRE <br /> f4L <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) C3 DOG KENNEL G DAIRYY <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> In TIERED PERMITTED FACILITY ❑MOTEUHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIEROING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILARLE FOR REVIEW• MONDAY-FRIDAY 6:00 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(209146"138 or mail to thq 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 /> EHD 40-02-000 <br /> 1HU08 <br />