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APR-25-2005 11:23 F BANK LODI MAIM P.01i02 <br /> ;5A.N JUAQUITI %,V iV t Y <br /> ENVIRONMENTAL HEAL DEPARTMENT <br /> 304 East Weber Avenue, 3rd Ploox, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web--www.sjgov.org/ehd <br /> PUBLIC .RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 l~� �1 L.1r1L� BUSINESSIAGENCY: <br /> ADDRESS: i Z- f <br /> PHONE(1): PHONE(2). FACSIMILE: <br /> I <br /> TENTATIVE*APPOINTMENT DATE`. Zg � Time: v <br /> (Please allow 10 business days from data of Elco Ion subm ttal rTentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$9 0 SH OR CHECKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE f -S/ <br /> UNIT DISTRIBUTION ❑ Unlit 1 ❑ Unit 2 0 Unit 3 0 Unit 4 0 Unit 5 ❑ Unit 8 ❑ Other(alectroniclll"maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Noma C <br /> J. .., L C <br /> 2. <br /> _2__ <br /> 4. � <br /> 5. <br /> 7. <br /> 8. <br /> 9, .� <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEP RTMENT FILES <br /> 0 UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑HouslwG ABATEMENT 0 SOLID WASTE FACILITYrvEHICLE { <br /> 0 QTHER CLEANUP SITE(NON-LOP) ❑F000 FACILITY ❑ WARYE=TIRE <br /> C5 UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> ❑HAzAKDOUS WASTE GENERATOR M CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTELIHOTEL n PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOoIBODY PIERCING ❑POOIJSPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECT ) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MOND Y•FRIDAY 8:00 AM-5:00p I • EXQL.UDING HOLIDAYS, <br /> 1. List up to ten addresses In the space above. Select the type( )of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0135 or mail to the address <br /> indicated above. Address ranges will not be accepted-for a ditional assistance with file addresses, contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> Y. 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 f les will be held for a maximum of five business <br /> days for review. Appointments should be scheduled ar-cordir gly. <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 flle 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 requ ire a $93.00 deposit prior to review. <br /> EHD 4042-006 <br /> inMas <br /> � l <br />