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01/23/2006 15:20 FAX 1 209 231-' 727 STOCKTON Z001 <br /> EHD L03 NUMBER <br /> DATE RCCEIVED SAN JOAQUIN COUNTY <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> Telepbone: (209)468-3420 Fag:(209)464-0138 Web: Www.sj1a5�rg/e� <br /> �JAA 3 PCS 3: �$ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: j> rrlN BUSINESS/AGENCY: LL' > ��?C1017e5 <br /> ADDRESS: / e +� C,& <br /> PHONE(1): C2OR)1-34 Z'Z PHONE(2): ml 6)611—OQ�JS__ FACSIMILE: 7 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> Cl CHECK BOX TO EXPEDITE REQUES $93.00 F (C=AC <br /> HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2 t7 <br /> UNIT DISTRIBUTION 0 UnV1 0 Unit 2 0 Unit 3 ❑Unit 4 ❑Unit 6 ❑ Unit 6 0 Other(electronicfl"tstslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> S Street# Street Name City <br /> F4. <br /> bl o D O M Stac.fc <br /> _ <br /> �P <br /> 6. <br /> 7. _ <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> k UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT M SOLID WASTE FACILITYfVEHICLE <br /> K OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ,KUNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> Pr.HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOOIBODY PIERCING 13 POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-6:00PM - 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 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 /> EHD 4E-02-006 <br /> 1114106 <br />