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12/22/2005 11:37 FAX 925 945 6485 WESTON WALNUT CREEK IM002 , ,( <br /> DATE RECEIVED — EHD LOG NUMBER (�( <br /> SAN JOAQUIN COUNTY <br /> ENviRoNMENTAL HEALTH DEPARTMENT /� 473 <br /> 304 East Weber Avenue,3d Floor, Stockton,CA 95202-2708 / <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.Sjgov.org/ehdL <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: T,r, FDc*r`ec L ` (BUSINESS/AGENCY: WeSA_OR SOI Oft$ <br /> ADDRESS: I S 1 S !Q -I. 13%\/J. SV-+e— (�, W0AV\Uk CVeeK C 1\ CILq <br /> PHONE(1): A�O �55 PHONE(2): zs �1�� G©b FACSIMILE: !zS QyGr' CO( <br /> TENTATIVE'APPOINTMENT DATE: A�`e �r ;n Jan uo-ry 200("Time: <br /> (Please allow 10 business days fromdate t application submittal-'ien[ative only-must be confirmed) <br /> 171 CHECK BOX TO EXPEDITE REAUESi-$93 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT '/ DATE (2)22-16 S <br /> UNIT DISTRIBUTION ❑ Unit 1 r3Unit2 12UnR3 OUnit4 ❑ UnItS ❑ Unit6 ❑ Other(electronlc/listslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> stl.eti Strad Name city <br /> 1. r\ ST <br /> 2. O IG n ST V <br /> 3. n r c <br /> 4. \� <br /> 6. c c <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. f� <br /> Specific Date Range of Infcamation Requested:From 19 lys- to t r�S-c.�'♦- <br /> ✓ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP Sm[(LOP) ❑HOUSING ABATEMENT ❑SCUD WASTE FACIUTYIVENICLE <br /> �ER CLEANUP SITE(NON-LOP) En FOOD FACILITY ❑WASTE TIRE <br /> ERGROUND TANK(MONITORINGIRemovAL) ❑DOG KENNEL 173 DAIRY <br /> WYAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH ❑WASTEwAIER TREATMENT PLANE <br /> CWTIERED PERMITTED FACIUTY ❑MOTELIHOTEL 0 PUMPER TRUCKNARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING yOy�PPOOIISPA 13 LAND USE APPLICATK)N SITES <br /> 171MEDICAL WASTE FACILITY &"61ER(PLEASE SPECIFY) QSiP` CS�5 �CMIFS Or � SCl+P14y Gt,rmCl� <br /> WELL AND SEPTC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY6:00AMS:00PM - EXCLUDINGHOLIDAYS. <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)464.0139 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. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten (1(I)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 /> d <br /> END 48O 4106 <br /> 1n{OS <br />