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DATE Sao ,DbG stern r.nailD3 <br /> • SAN JOAQUIN COUNTY <br /> �� ENVIRONMENTAL HEALTn DEPARTMENT <br /> 304 East Weber Avenue,aro Floor, Stockton, CA 95202-2708 i— <br /> EWR(3PrAf 2OO5Telephone:(209)468-3420 Fax:(209)464.0138 Web: www.sJBovHEALTH .org/ehd (n <br /> _ <br /> PER MITIS RVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:1 e kAA1 BUSINESSIAGENCY! 1= N�tZ <br /> ADDRESS: 11 O _ SpC�i UAgkQ l r& 9S4 r? 7 <br /> PHONE(1): QI(O 2.t3�, tygQJCI PHONE(2): gie �� -T(p� <br /> —�s1•. FACSIMILE: 411e $t^a Qmn <br /> TENTATIVE'APPOINTMENT DATE: IQ IrJ IOS 0 <br /> (PNIas9 i1low 10 business days tram date of application submittal- Tentative on]Y Time: <br /> y•must be con _ <br /> In CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED I - <br /> SIGNATURE OF APPLICANT DATE <br /> UNrrDISTRIBUTION El Unit ❑ Un 3 UnR4 M UnitS Unit <br /> 6 ❑ Other(eleetroniUlists/maps) <br /> FILE A REBS <br /> Street IT street C• EHD USE ONLY <br /> 7 S fi —r1a � <br /> 2. b k <br /> 3. UST - - <br /> 10. <br /> Specific Date Range of Information Requested: From x, tos�(`rE' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Id UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 84 SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY I WASTE TIRE <br /> Lit{UNDERGROUND TANK(MONITORINOIREMOVAL) ❑DOD KENNEL 13 DAIRY <br /> 1A HAZARDOUS WASTE GENERATOR M CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 1A TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA 13 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILM ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-6:00PM - 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. <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 /> ERD K-02-006 -- <br /> 1114M6 <br /> TOTAL P.01 <br />