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02/13/2006 10:32 FAX R002/002 <br /> DATE RECEIVED 0 SAN JOAQM COUNTY • EHD LOG NUMBER <br /> ENvcRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 /� I <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd (// �w <br /> PUBLIC RECORDS RELEASE APPLICATION 7 <br /> APPLICANT: IVq'r[A415-1 - haq d BUSINESfSIIAAGENCY: I <br /> ADDRESS: Ztl �� r-- . M`(C1 L-� 9 1 CITY J 1 C /V STATE_,_ <br /> PHONE(1): ?j't—9 <br /> 7 3d -(-�N r PHONE(2): FACSIMILE.-b-P— 9`/1"—fib Zl <br /> TENTATIVE`APPOINTMENT DATE: ZI7 7 ID fn Time: _ <br /> (Pkase allow 10 business days from data of appReaffon submldal-`Tmfaff"only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQ �ST-;93.00 F (CA/S�OR CHECK ONLY)-REQUEST PROCESSED IN s BUSINESS DAYS <br /> SIGNATURE OF APPLICANT — !�(.r4vC l DATE <br /> Electronic c ❑ List ❑ Nap-Dsscripnon <br /> Infort rmroni <br /> FILE ADDRESS EHD USE ONLY <br /> stnetf Street Name Cay <br /> 1. br ❑ Unit 1 . <br /> 2. <br /> 3• /- Unit 2 <br /> 4. <br /> s. Unit 3 <br /> s_ Unit 4 <br /> 0. ❑ Unit 5 <br /> s. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1 <br /> 7}1NDERGROUND TANK(UST)CLemup SnE(LOP) CI MOWAsATF IZNT M SOLD WASTE FACILRY/VEHICLE <br /> PJ}PTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ,,❑yyWASTE TIRE <br /> �j1NDERGROUND TAw(MONRORIHWFtemovAL) ❑ DOG KENNEL y gPIkY <br /> ,, HA2ARDOU4 WASTE GENERATOR 0CHK7SEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PE&VMD FACILITY 0 MOTPJJHOTEL ❑PUYPERTRUCIJYARUICNERuCAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑PMJSPA ❑LAND USE APPLK:ATTON SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT REOORDS ARE AVANABLE FOR REVIEW-MONDAY-FRDAY 0:00 AMd:00RM - EXCLUDING HOUDATs. <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 /> approprlate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail 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 /> Z <br /> END 4946 <br /> twal![o06 <br />