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05/03/2OE6 11:34 209-579-W MODESTO ATC FAGE 02 <br />EHD LOG NWBER <br />DATE RECE IVEO SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT I <br />304 East Weber Avenue, 3`4 Floor, Stockton, CA 95207-2708 <br />Telephone: (209) 468-3420 'Fax: (209)464-0138 Web: wWw.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLIC NT:jIN%t t( °7�j� BUSINESSIAGENCY:AT& <br />ADDRESS: hLl <br />PHONE ():.Z18'15 i� ��� ` PHONE (2): FACSIMILE: Z15A • 7 <br />TENTATIVE' APPOINTMENT DATE: 5' I9• U6 rITM: - •"" <br />(plea" all" 10 buainna days from dab of opplica m submltki-'Tadeum only - mutt be canflmwd) <br />CHECK. BOY TO EYPE RE��tP)E T 593.00 FEE (CASH OR CHECK ONLY) - RECNIEST PROCESSED IN 3 BUNNa,E33 DAYS <br />SIGNATURE OF APPLICANTT 'T3 �)a DATE <br />Specin <br />Date Range of Information Requested: From ST <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />TA (UST) CLEANUP SME (LOP) ❑ Haimma ABATEMENT <br />ynAo WABiE F..AaLITY(VEHICEE <br />AUNOEROROUND <br />OTHER CLEANUP SITE (NOW -LOP) O FOOD FACanY <br />❑ Wmm TuuE <br />UNDERGROUND TANK (rAGNITORINGfF EMCVAL) O OM KENNEL <br />O DAIRY <br />HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br />0 WASTEWATER TRENTNENr PLANT <br />PSTMRW IMITTED FACILITY ❑MOTELRWTEL <br />O PumnR TRUCKIYARGICHEM TOILET <br />❑ TATTOOMODY PIERCING 13 POOLISPA <br />❑ LAND USE APPLKATION CM <br />'P MEDICAL WAOTF. FAcnrtY ❑ Omm (Pima$ srza ) <br />WELL AND SE 1C PERNST RECORDS ARE AVAILABLE FOR REYEw -MONDAY-FraDAY COD Aa1R:00PN1 � EXCLUDING MOLRIAYS. <br />1. List up to ten addresses In the space above. Select the type($) of files from the list above by checking tho <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-D138 or mall to the addresa <br />indicated above. Address ranges will not be accepted -for additional assistance with file addressos, contact <br />the EHD. Applications roceived after 3:00 pnl 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 />approximaley ten (10) days after receipt of application. The files will be held for a maximum of five business <br />days for review. Appointments ahould be scheduled accordingly. <br />3. A flee that 13 actively being worked on by EHD staff may not be Immediately available for revlow. 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 tit the expense of the <br />rl t view <br />applicant. Future file reviews by the same applicant may require a 503.00 depnsE p or o re <br />EHD A"2,H 1 <br />1PIN01 <br />J <br />