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01/23/2006 15:20 FAX 1 209 234 7727 STOCKTON V001 <br /> EHD L03 NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTn DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web: www.sjgov.or ehd <br /> 2086 JAN 23 PH 3= 48 <br /> PUBLIC RECORDS RELEASE APPLICATION I , <br /> APPLICANT: J CIC&N &VIAL B'U-SIINES-SIAGENCY: i1 ' jJ �fjdCIa45 <br /> Sq10 idA+ ilmADDRESS: W(mee 6(4;l e 1l , .r�'t0C-�fi 1 t CA, <br /> PHONE(1):f20%)234—IT ZZ PHONE(2): IgI0ST�'���JS —FACSIMILE: �� <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> 171 CHECK BOX TO EXPEDITE REQUESTr$93.00 F (CX%A <br /> HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT G DATE I 2 <br /> UNIT DISTRIBUTION ❑ U 1 ❑ Unit 2 0 Untt 3 ❑Unit 4 ❑Unit 6 ❑ Unit 6 ❑ Other(electronicll'ists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name - - City <br /> F2- <br /> : <br /> t r. <br /> 4. _ - - <br /> 6. - - �P <br /> 6. <br /> 7. <br /> 10. y <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT O SOLID WASTE FACILrTYNEHICLE <br /> 1�OTHER CLEANUP SrTE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> PK <br /> HAZARDOUS <br /> TANK(MONITORINGIREMOVAL) 13 DOG KENNEL El DAIRY <br /> PKHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH M WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPUCATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 5:00 AM-5:00PM - 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 ad tress <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 /> EHD 4E-02-M <br /> 1114105 <br />