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06/01/2005 17:35 530676E - STRATUS NO CALIF PAGE 01/0 <br />DATE RECEIVED L G IJrBE� <br />SAN JOAQUIN COUNTY V <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3`d Floor, Stockton, CA 9520 I►►'j�jj�,jj�� <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwws;nv"ot�2ra <br />PUBLIC RECORDS RELEASE APPLXCA7� MFKIT <br />kTNE14T <br />APPLICANT: I BUSINESS/AGENCY: <br />ADDRESS r ^`it <br />PHONF (1): i530� ��� - �a4 PHONE (2): 530 - FACSIMIL <br />TENTATIVE' APPOINTMENT DAT <br />(Please allow 10 business day <br />r t 1p n su -'7 s only - must be confirmed) <br />CHECK BOX TO EXPEDITE REQUEST 93.00 F CASH O CHEC O1�Y) - QUEST PROCESSED IN 3 SUSIN SS DAYS <br />SIGNATURE OF APPLICANT PATE lL I <br />UNIT DISTRIBUTION ❑ Unit'! 10 Unit 2 ❑ UnitIl ❑ Unit 4 C1 Unit 5 ❑ Unit G ❑ Other (electronic ' a A <br />:a. <br />S <br />FILE ADDRESS EHD USE ON <br />Street ak Street Name City <br />L <br />\ 2. <br />\ 3. -L <br />� 4. 2 <br />5. <br />6. <br />7. 11911 11011r r if Ir! III <br />8. - - — REJ�EEE 1 <br />Specific Date Range of Information Requested: From to Fra,< I, A4 - <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />�1NDERGROuND TANK (UST) CLEANUP SITE (LOP) <br />Cl HOUSING ABATEMENT <br />O SOLID WASTE. FACILFry(VEHICLE <br />9Z OTHER CLEANUP $ITE (NON -LOP) <br />Cl FOOD FACILITY <br />13 WASTLE TIRE <br />JNDERGROUNO TANK (MDNrrORINGlREaIovAL) <br />0 DOG KENNEL <br />d DAIRY <br />HAZARDoUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />C3 w T ATS T TNEIIT PLANT <br />❑ TIFRED PERMIT= FACILRY <br />O MOTELIHOTEL <br />0 PUMPER TRUCKIYARDlCHEm TOILETS <br />❑ TATT001BODY PIERCING <br />❑ POOL/SPA <br />❑ LAND USE APPLICATION SITES <br />a MEDICAL WASTE FAGUTY <br />O OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FR10AY 8:00 AM-5:00PDA - 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 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 />END 48 -02 -OK <br />1114fu <br />