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Oct 03 05 11,26a Drew Van Allen_ I 209 667-9668 p.1 <br /> DAT REGEN ti EH[}LOG NUMBER <br /> SANJOAQMICOUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor!, Stockton,CA 95202-2708 <br /> Telephone:(209)458-3424 Fax: (2 09)454-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT- ��'� `! a ���t/� ,} <br /> BUSINI aSlAGENCY: <br /> ADDRESS: ZITZ' ��alt•)-L p�tw` i otiY+ , 44 ; - <br /> PHONE(1): Z.%-W°I '�.Ll ..- PHONE(2): ZoF u - Co `( FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: �� l.�(tam Time: <br /> (Please allow 10 business days from date of application subrnittai-'Tentative only-must tic confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-; 3.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 313U INES5 DAYS <br /> SIGNATURE OF APPLICANT ���-�`�-- DATE f��5�a�~ <br /> UNITDISTRIBUTION M Unitl C1 UMI:2 ❑U Unit4 Unit 5 D Unita C7 0t1w(electranlc/listslmaps) <br /> FILE ADDRESS I <br /> Street al Sweet Name City EHD USE ONLY <br /> 1. Z IQ o ra c ru#- Frt,,0q C o <br /> 2. F1 <br /> 3. x-F,'--4-- <br /> k4.. S4,0GIL n <br /> Specific Date Range of Information Requested:From 2003 to Oj J <br /> I _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> _ _R <br /> _d OTHER CLEANUP SJTE{US f)CCIEANflP51TE'(L�P)— "" oH'USfNG TEMI F17 50uD WASTE FAC TYNENIGLE <br /> (NON-LOP) E3 F000 FAccuTY 0 WASTE TIRE <br /> C3 UNDeRGRouNOTANK(MONTORINWREMOVAL) ❑ DOG KENNEL t3 DAIRY <br /> ❑HA7ARDOUs WASTE GENERATOR a c1-tC9EN RANCH C3 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MIOTEUHOTEL ! M PUMPER TRUCKIYAROrCHEM TOILETS <br /> 13 TATTOOIBODY PIERCING ❑ POOUSPA ❑LANo USE APPLICATION Sams <br /> 13 MEDICAL WASTE FAcii." C3 X?rHER(PLEASE S i ECIFY) <br /> WELL AND SEPTC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- NT0NDAY•FRIDAY 5:00 AM-6.00Pm - ExcLUDING}{DUDAYs. <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 exisL Anj 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 S93,00 deposit prior to review. <br /> I <br /> EH0 4"2-006 <br /> 1H4fiS ' <br /> I <br /> I <br /> I <br />