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05/03/2005 15:13 FAX <br /> �n11 <br /> Q001 <br /> \' <br /> DATI 3ECEIVEO FHD LOG NUMBER <br /> `�J(�� 1% �D SAN JOAQUIN COUNTY <br /> U Y V� L�C� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 ` J <br /> MAY 0 ?005Telephone: (209)468-3420 Fax:(209)464-0138 Web: www.sigov.org/chd <br /> EWRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> Ir I VCG" � '�' Q1 <br /> APPLICANT: I ptn1-� BUSINESSIAGENCY: &&A'j �rtv7MNVNP <br /> ADDRESS: LI CJ �Orl- (llnirn n,v� y A _ <br /> PHS,NE(1): ql )2-99 - 7 384 PHONE(2� FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> rUNIT DISTRIBUTION ❑UnR i ❑Unit 2 ❑Unit 3 ❑Una 4 ❑Una 6 ❑ Unit6 ❑ Other(electronic/lisWmaps) / <br /> 2 <br /> FILE ADDRESS EN USE O Y <br /> US t Street b Street Name City11FAII&APAININ 11, <br /> 1 A <br /> US y. 76 <br /> 3. Oa <br /> C <br /> 4. �E'I Ce <br /> 5. Vi <br /> G. <br /> 7. RM V If <br /> NA 11LAW <br /> 8. <br /> 9. <br /> 1 D. <br /> fl <br /> Specific Date Range of Information Requested:From Alf to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Fdl UNDERGROUNII TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACOUTYNEHICLE <br /> EI In HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> LT UNDERGROUND TANK IMONITORINGIREMOVAL) ❑DOG KENNEL ❑PA IRYAil <br /> 6Ti H AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH IN WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL 13PUMPER TRUCKNARDICHEM TOILETS <br /> ❑ fATT00/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FAOILm' ❑OTHER(PLEASE SPECIFYI <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:08 AM-5:00PM - EXCLUDING HOLIDAYS. <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 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$93.00 deposit prior to review. <br /> E�in,e-maos ._. <br /> tl i.l)6 <br />