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MAR.10.2005 10:59AM Al" ENVIROTECH,INC. � N0.289 P.1 � <br /> �A EMD LOG NUMBER <br /> DATE RECEIVED (� SAN JOAQUIN COUNTY <br /> RE(r�rF= <br /> ��1�� NVIRONMENTAI.HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3 Floor, Stockton, CA 95202-2708 <br /> MAR 1 0 2005 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www-sjg0v.0fg/ehd . <br /> 1RONMNT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> A T: �`^ __ .A BUSINESS/AGENCY: <br /> IA <br /> ADDRESS- <br /> PHONE(1): <br /> DDRESS:PHONE(1): PNONE(2): ��T «� "fib FACSIMILE: <br /> TENTATIVE°°APPOINTMENT DATE: **i` ?"-k-Z"%Q Time: 04 <br /> (Please allow 10 business days from data of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK SOX TO EXPEDrm REQUEST-$93.00 FEE�(C�ASAH OR CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �''r"v` -` DATE 3�t4to fr <br /> UNIT DISTRIBUTION ❑Unit 1 13Unit 2 ❑ Unit 3, Unit4 Unit 5 C] Unit G Cl Other(sloctronl0listslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> gqt# Street Name City <br /> S v�c.K 3 4; ° ! <br /> 3. eld�S�w S4�ct� `� L0a. I� tts=> l �.Mre 4 ! r 3�.t. <br /> 8. ZCS <br /> u73 <br /> r`oS -avr+► a S 1+1 t^�,t1: <br /> P' <br /> Specific Date Range of Information Requested:From l to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IJNDERGROuND TANK(UST)cLEAMuP srm(LOP) C3 HOUSING ABATEMENT A SO{_ID WASTe FACRMNEHICLI: <br /> 0 OTHER CI.gANUP SITE(NON-LOP) <br /> C3 FOOD FACIl1TY 0 WASTE TIRE <br /> A UNDFRRGROUNOTANK(MONITORINGIREMOVAL) d DOG KENN% ' 0 DAIRY <br /> C3 HAZARDOUS WASTE GUIERATOR Q CHICKEN RANCH A WASTEWATER TREATMENT PLANT <br /> 0 TIERED PeR mrTm FAciuTY ❑MoTeUHoTEl Q PUMPER TRUCKIYAR0ICHEM TOILETS <br /> Q TATTOOIBODY PIERCING <br /> Q POOUSPA 0 LAND USE APPWATION SITES <br /> MEDICAL WASTE FACIL nY 0 OTHER(PLEASE SPECIF1f) <br /> WELL AND SUMC PERMIT R CORIDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 5,00 AM.5:00PM - EXCLUDING HOLIDAYS. <br /> i, 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 /> i 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 /> EHO 4e-02406 <br /> tnu0s <br />