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09/06/2005 09:23 916-371-1809 RANEY GEOTECHNICAL PAGE 01/01 <br /> 0 %V <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 <br /> SEP 6 2005 Telephone:(209)408-3420Fax: (209)464-0138 Web: WWWAjgov.vzglchd <br /> 1q7 7 <br /> UNIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> EUSWESSIAGENCY:F :!!L-- _4 � ^►�tc�('I M e <br /> ADDRES3: 1t7 , 7 SL�G(rGC n�y <br /> Q E*ra J -6�3 PHONE(2): FAG IMIL 't I(a r <br /> PHONEo <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal-*Tanfattm only-must be conflrmedl <br /> CHECK BOK TO EXPEDTfE REQUEST-S93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT IA$TRI6U110N ❑ tlnk 1 ❑Unit 2 nit 3 ❑ r4 ❑ Unit 5 ❑ Unit& C7 Other(eleatraniclllstslmapa) <br /> FILE ADDRESS EHD USE ONLY <br /> 3trrc#iF Street Name city <br /> L3 - - } <br /> - 1 <br /> 7. . <br /> $. - VIA - <br /> 10: - . <br /> I ----k--U <br /> Specific I]aRange of inform Re asted:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ZV611DERGRGUND TANK(UST)CLEANUP$ITE(LOP) 0 Housmo ABATEMENT 0 SOLID WAATE FACILfTYIVEHIOLE <br /> ❑OrHER CLEANUP SITE(Nom-LOP) :3 FDOD FAr-ii F d WASTE TIRE <br /> 17���fN�K�ROROUHO TANK(MONrrORINGIREMOVAL) 73boG KENNEL b DAIRY <br /> Zl+[/LARDOU9 WASTE GEHERAtWe 11 CHICKIIN RANCH 1:1 WA EWArm TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY <br /> 0 M4r"OTEL a PUmPEATRmKlYARDfCHEMT0%eT9 <br /> ❑TATroolsooy PIERCING 0 POOLISPA 17 L.ANo Use APf ucATION Sn-Es <br /> Q MEDICAL WASTE FACILITY 0 OTHER(PLEASE$PCCIF:y <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAKE FOR RFMEw - MoNDAy-FRIDAY 9:00 Am-5.00PM - LXOLUDNG'HOUDAY9. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the fist above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2Q91404-0138 or mail to dress <br /> indicoed 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 hold 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$93.44 deposit prior to review. <br /> EHD<A-02-0OA <br /> 11MOS <br />