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Apr. 15. 2006 4:32PM Advanced Geo Environmental No. 174BEHDPt.,1.auMBER <br /> �� ��'I _L0 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN <br /> APR 1 0 200$ 600 East Main Street, Stockton, CA 95202-3021 <br /> _ Telephone: (209) 468-3420 Fax: (209)464.0138 Web: www. 'gov eh Y.3 <br /> ENVIRONMEN I HEALTH <br /> PEPUAT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: `) /'LLb'1'ZriC,. BUSINESS/AGENCY: ) <br /> ADDRESS: (3 ?)7 Y IL <br /> PHONE(t): Q069 (A27-IDS,- PHONE(2): FACSIMILE: •/-/�IS <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dale of application submittal.'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUU,4T.$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN/3BUSINESS DAYS/ <br /> SIGNATURE OF APPLICANT l'�fr EC,'; 'i l / G.S '. DATE ` —15 V <br /> Electronic Information: [] List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> nnSttr'eet# Street Name City El unit 1 <br /> �.1Tv^�! til `�J �/ 60 ..� CI - ILI CS <br /> e C <br /> v raC� I C'T(�,V CTS �Y �t' F 115` CSL 0 6Unit <br /> i I(c GLC at,M C'4'L`Fz "sf-T'e( t <br /> -..38 j.. 9l Jri P'E' �.l)L'�L - <br /> /10110 <br /> 3unit 3 <br /> S222 <br /> Unit 4 <br /> J. <br /> ;gin Lfty Selw�> Ii' �. <br /> Lf 1 -- ❑ Unit 5 <br /> 9- —n11T/0.� �" units <br /> 1� 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> YLp� jr <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE •,i, <br /> ❑ OTNER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY M WASTE TIRE I I <br /> � <br /> UNDEROPOUNo TANK(MONITORING/REMOVAL) ❑DOG KENNEL 173 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0(� ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT -1 <br /> TIERED PERMITTED FACILITY M MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> 171 TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACIuTY CJ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY S:00 AM-5:00PM • EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(ea). At least one file type MUST be selected. Fax to(209)464-0138 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 /> 300 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 application. The files will behold 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 Nle not retumed in the same Condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future fife reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 WEB&0/1007 <br />