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V0/V1/ZUV0 10:U4 rAA UZ064ZZUZZ UUMV.LAW LgjUU1 <br /> tr1U tVCi fYVMtltI'< <br /> DATE RECEIVED� - SAN JOAQUIN COUNTY <br /> [1 v 11 U v ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> JUI 0 2 2005 Telephone' (209)468-3420 Fax: (209)464-0138 Web:www-sjgov.org/ciid <br /> 0V <br /> WARONI MENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �L� BUSINESS/AGENCY: �U t rT• �'�lyw ma d <br /> ADDRESS: © r q2,(- � <br /> PHONE 0)� �'I�� PHONE(2): F Time. <br /> TENTATIVE"APPOINTMENT DATE:_�L,.��c Time: Uv <br /> (Please allow 10 business days from date of application submittal-"Terttaflva only-must be confirmed) <br /> 0 CHECK 13OX TO EXPEDITE I EQ ST-$93.00 FFE CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> UNIT DISTRIBUTION <br /> ❑ Unit 1 O Unit 2 400Mit Unit ❑Unit S Cl Unit 6 ❑ Other(elactronicAlswMaps) <br /> FILE ADDRESS EHD USE ONLY ►�)'��.QS <br /> street# Street Name city <br /> 1. -0 <br /> 2.- <br /> 3. <br /> 4. <br /> 7. <br /> a. <br /> 10. to (r(� f- <br /> Specific Data Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> C3HOUSING ABATEMENT o soLw WASTE FACILiTYIVEHICI.[ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) p FOOD FACILITY d WAST£TIRE <br /> OTHER CLEANUP SITE(NON-LOP) U DOG KENNEL ❑DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PUNT <br /> d HAZARDOUS WASTE GENERATOR 0 CHICKmoTELJI RAN ❑PUMPER TRUC14NARDICH€M TOILETS <br /> 13 TIERED PERMITTED FACUATY p POOLISPA ❑LAND US G APPLICATION SITES <br /> ❑TAII OO/I30DY PIERdNG ❑OTHER(PLE°G SPECIFY) <br /> C]MEDICALWASTEFACILITY <br /> WE'LL AMC)S>=PT1G P�MIT RECORDS ARE AVAllAR1-E POR RL:`/I�l- MONDAY-FRIa►Y 8:00 AId-5:0OPM - EXCLUDING HOLIDAY • <br /> checking the <br /> 1. List up to ten addresses in the spac® above. Select the type(S)of files from the list above bto the addres!� <br /> y <br /> appropriate bOX(es). At aran ne le ty es Will of MUST be be accept dE ctefordsdditional ass 464stance with file�01 38 or mailaddresses,contactindicated above. Address9 <br /> next business da <br /> the EHD.Applicatlons received after 3:00 pm will be processedappointment for review will be confirmed <br /> 2. The EHD will notify the applicant if any EHD fifes exist An <br /> approximately ten(10)days after receipt <br /> Of scheduled accohdinglywill be held for a maximum of five business <br /> days for review- Appointments should <br /> 3. A file that is actively being.Worked on by EI-10 staff may not be immediately available for review. Anew <br /> application may be subraitt4--taken the file is available. <br /> 4. Any file not returned in the same condition applicant eased will be.reorganized by EHD Staff a the expense of the <br /> applicant. Future file reviews by the same may requre a$93.00 deposit P <br /> —=Wit;-. •.... - <br /> EHD 18.02-008 <br /> 1114!06 <br />