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11/02/2007 14:20 9165622 KRAZAN FFtU PAGEUlv02/02 <br /> DAT���IVEo�® SAN JOAQITIN COUNTY <br /> ENVIRONMENTAL HEAurn DEPART MEN" <br /> Oa7 304 East Weber Avenue,3rd Floor,Stockton,CA 95201-22 1 <br /> NOVV 2 Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.s ov. d <br /> ENVRiRONMENI F4EAL" PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAGENCY: <br /> d' cj Scl prd 7" .• <br /> APPLICANT: <br /> 1 _ <br /> ADDRESS: ��taE S`1f'�/L.,F'1" :f"� 1ff c'l.E•:�G..�'19 ., t,-"i,E4'-i::"1 <br /> < ���; d,'r7' { :7C ly/ --FACSIMILE: <br /> PHONE(1): >.:cF..."',T:?`%;i PHONE(2): — _ <br /> Time: <br /> _ _ me: <br /> TENTATIVE"APPOINTMENT DATE: must be confirmed) <br /> (Please allow 10 business days from date of application submittal-'Tentbfive only- <br /> 7(J YS <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00(= E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN]BU1 Ef SDr <br /> ✓ DATE <br /> SIGNATURE OF APPLICANT <br /> Electronic Information ❑List❑Map Description - - <br /> EHD USE ONLY <br /> FILE ADDRESS <br /> Street if J Street Mame <br /> .J�f.,C�•f`_ ./+,! . G nit <br /> z Al <br /> 0 4' — —— —"----- _—�.— -- <br /> - — — _— Unit <br /> y.4 S• ._-.—.— --_-- — —.— Unit 5 <br /> 7. <br /> 8. - y — -- - -- - - — Unit <br /> to —�---- — <br /> Specific Date Range of Information Requested:From P RTMENT FILES <br /> ENVIRONMENTAL H <br /> ❑Hous eM�orr X—I'dWASTE FACIUTYNEHR:LE <br /> U NDERGROUNDTANK(UST)CLEANUP SUE(LOP) CI FOOD LI 0WASTETIRE <br /> OTHER C'E' SITE(NON-LOP) ❑DOG KE EL 0DAIRY <br /> UN0 RGROUND TANK(MONRORINGIREMOYAL) ❑CHICKEN RANCH dWA3TEwATER TREATMENT PLOT <br /> I,OUSWASTE GENERATOR Q MOTELIHOTEL ❑PUMPERTRUCKIYARDICHEM TOILETS <br /> TIERED PERMITTED GEN <br /> Y ❑POOIISPA [3 LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑OTHER(PLEASE SPECIFY)— —.� <br /> rl MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY-FRIDAY 8:00 AM3:OOPN • EXCLUDING eappr <br /> 1. List up to ten addresses in the space above. Select the types)of flies from the list above by checking the appropriate <br /> Applications received after <br /> box(es), At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address indicated above. Ad dress <br /> ranges will not be accepted—for additional assistance with file addresses,contact tho EHD.App'- <br /> 3:00 pm will be prgcessed the next business day. <br /> lication. The files will be held for a maximum of five business days for review. Appointments <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 app <br /> should be scheduled accordingiy. Ilcation may be <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew app' <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$95.00 deposit prior to review.-. <br /> EHD USE ONLY ------ <br /> EHU A0A6 3�1�2W6 <br />