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T Apr. 15. 2008 4:32PM Advanced Geo Environmental <br /> [`)il l-t[iMO . SAN J•OAQUIN COUNTY � No. 1748EHDP:, 1AUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMEN <br /> EfVVIRC?N(�dEty T HEALTH c <br /> APR E c 2808 600 East Main Street, Stockton,CA 95202-30293 J Y.,.3Telephone:(209)468-3420 Fax: (209)464.0138 Web: www. 'gov. eh <br /> PERA T/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> La. '/'LL •Zc>i... BUSINESS/AGENCY: <br /> ADDRESS: 7 S � <br /> PHONE(1): 6ZV�/ *7 /D/)I> PHONE(2): <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal- Tentallve .Time: <br /> Timmust be confirmed) <br /> CHECK BOX TO EXPEDITE REQU 9T-$98.00 FEE 4C�9H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,( �C f fi, ,��( DATE U <br /> v <br /> Electronic Information: [] List❑ Map-Description: <br /> -------------- <br /> _ FILE ADDRESS <br /> streetA "RUSE ONLY <br /> " ' — <br /> G <br /> Streat Name Clty If ❑ <br /> I � Unit 1 <br /> / ) e� 1, <br /> 1;..� . L' �,i,✓ " 27"L� u'�Y' ` f'AIS` Ll •"'i D 8( ' . S / Unit 2 <br /> n� a7 (tCYclalneuL♦v J+Yet' ko <br /> /0110 <br /> Unit 3 <br /> unit 4 <br /> 8. - 1-4 ci "f ` El <br /> 5 <br /> 9 <br /> C]/unite <br /> Specific Date Range of Information Requested: From to / <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT �/ r <br /> LJ OTHER CLEANUP SITE NON-LOP rol WAST WASTE FACILITYNEHICLE �( <br /> UNDERGkOVNO TANK(MONITORING/REMOVAL)(� C1 DOG KENNEL <br /> FACILITY WASTE TIRE (f ►') f•/� <br /> HAZARDOUS WASTE GENERATOR OC 0 DAIRY `�v <br /> 0 TIERED PERMITTED FACILITY 0 CHICKEN RANCH Cl WASTEWATER TREATMENT PLANT -I <br /> 0 TATTOWBODY PIERCING 0 MOTEL)HOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 MEDICAL WASTE FACILITY 0 POOL/SPA ❑LAND(ISE APPLICATION SITES <br /> 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAaLE FOR REVIEW - MONDAY-FRIDAY 8:00 AIA-6:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type($)of fila$from the list above b checking the appropriate <br /> box(es). At least one file Y 9above. <br /> Address type MUST be selected. Fax to(2091484-0138 or mail to the address Indicated above Address <br /> ranges Will not be accepted–for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> days after receipt Of applicatlOm The files will be held for a maximum Of five business days for review. Appointments <br /> 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 application may be <br /> 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 applicant <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> PEHD48,06 WEB 802007 <br />