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11(20/2006 15:23 20283076 _ .._�L'EBID�IG-0 ___ PAGE 01/01 <br /> DATE RECEIVED END LOG NUMBER <br /> SAN JOAQuIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3'd Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/c <br /> PUBLIC RECORDS RELEASE APPLICATION,,� <br /> APPLICANT: J,I m &A') BUSINESS/AGENCY: <br /> ADDRESS: J z z 665¢- 'c 7 <br /> PHONE(1): ?Zg-.3075 ONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: ICG Sf (� G Time: <br /> (Pwaea allow 10 business days from date of epplicadon submittal-*"bathe only-must be aerdimad) <br /> ❑ CHECK eox ro EXPEDITE REQgel <br /> -$95. EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2C b <br /> Electronic Information: ❑LI ❑Map-Description: <br /> FILE ADDRESS END USE ONLY <br /> Street 0 Street Name City ❑ Unit 1 <br /> 1. 0 0 I Tkyrrt i6A Pd Sdxk,le,. kS 7J <br /> 2• 1055'5 t• t 11 Nr- Unit <br /> 3. <br /> 4 Unit 3 <br /> Unit 4 <br /> B. <br /> 7. <br /> ❑ Unit <br /> S. <br /> g. <br /> ❑ unit s <br /> 10. , <br /> Specific Data Range of Information Requested:From _ IQw to P1nS&^-rt7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Call <br /> JUNDERGROUND TANK CLEANUP SITE 0 HOUSING ABATEMENT ❑SOLID WASTE FACILr1Y/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑WASTE TIRE <br /> UN <br /> OEReRDUNO TmK(MowaRwGRtmovat-) ❑Doe KENNEL 0 DAIRY <br /> HAZARDOUSWASTE GENERATOR 0CHICKEN RANCH CO WASTEWATER TREATMENT PLANTT <br /> dTIERED PERMITTED FACILITY ❑MOTELtHOTEL ❑PUMPERTRUCKIYARWCHEM TOL-ETS <br /> O TATTDDIBOaY PirR01NG 0 POOUSPA O USE APPLICAMN Srrra <br /> D MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WEU,AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAYS:OOAM•5:OOPM - EXCLUNNGHOUDAYS. _ <br /> 1. List up to ten addresses in the space above Select the type(s)of files from the list above by checking the appropriate \�)♦`/r)' <br /> box(es). At least one file type MUST be selected. Fax to 12091464-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END files exist. An appointment for review will he confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3- A Nle that Is actively being worked on by END staff may not be Immediately A TKA appl;"MDI-maybe <br /> submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the some applicant may require a$05.00 deposit prior to review. <br /> EH13 USE ONLY <br /> FHP wa anazwe <br />