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12/22/2005 11:37 FAX 925 945 6485 WESTON WALNUT CREEK U 002 <br /> DATE RECEIVED 16 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 7.3Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/chd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: T��•-MIBU•SINESSlAGENCY: \112SvoR SOV <br /> -Ons <br /> ADDRESS: F -Qa- (S1yoL JVi'F_ �I2_ <br /> PHONE N16 TI &60 FACSIMILE: 1.5) 9, _2-;p. <br /> C ( <br /> TENTATIVE'APPOINTMENT DATE: Time; <br /> (Please alow 10 business days from daft f application submiu ;;only <br /> -must be confirmed) <br /> CHECK BOX TO EXPEDITE RV�EST-�t93�F�EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 7IfwS�� / DATE <br /> UNIT DISTRIBUTION ❑Unit 1 ❑ Unit 2 ❑Unit 3 ❑ Unit 4 ❑Unit 5 ❑ Unit 6 ❑ Other(electrunic/listslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Streot C Street Name City <br /> 1. <br /> Hol NO IT S Oc o rN ST ` <br /> 2. 111 P> 1-c��on eel 1oaK�cr� ST Q( <br /> 3• n4, Lis rAd XkTc�tS aK <br /> 4. <br /> 5. C c.V C rN <br /> 6. it <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Speck Date Range of Information Requested:From 19 IVT to Re r.,..-� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FActL [VeHICLE <br /> : <br /> ERCLEANUPSrrE(NON14P) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROl1N0 TANK(MONITORINWREMOYAL) ❑DOG KENNEL ❑DA Y <br /> DOUS WASTE GENERATOR 13 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> CIPTIERED PERMrTTED'FAcuTY ❑MOTEUROTEL ❑PUMPERTRUCKIYARDICHEMToeErs <br /> ❑TATTOOBODY PERCING ❑L.�PPOOL(SPA I� ` _ ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FActury Il &ER(PLEASE SPECIFY) A5%-es-'06 �rMt�'S Qr �tSCt�dlQy rX,nhrl� <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY8:D0AN5:00PM - E%cLUOINGHOLIDAYS. <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 mall 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 rifle 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 /> M(_\, <br /> `. <br /> END Ue 406 <br /> tn4p6 <br />