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Apr 1�-05-04:46p_ Drew Van Aller' 20' 7-9668 p.1 <br /> DATE RECEIVED EHD LOG NUMB <br /> A,PR ;� �� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ETVV'"0M4,xEN-1- 5-1 304 East Weber Avenue,3`d Floor, 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: f Zt*t4 AA BUSINESS/AGENCY: A—b-v,?c <br /> ADDRESS: Z- y�-� ti �D t�v-�-� Ire f ioILK CA <br /> PHONE(1): (o(o ���`1 PHONE(2): � L FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 5 3/�5 Time: �QD <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST'-$93.00 FEE(CASH O CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT bAo,-+� Vim.. DATE yL('81'0 S� <br /> Ab 0 <br /> UNIT DISTRIBUTION O Unit 1 ❑Unit 2 0 Uf 3 Unk jf C7 Unit 5 O Unit 6 ❑ OMer(electronicilistsimaps) <br /> FILE ADDRESS EHD USE ONLY (� <br /> OL <br /> W_: <br /> t# Street Name City <br /> kC,,�n S S1.nt k C� <br /> 6. t.tc�� c blvd. a <br /> 7. 1 <br /> 8. ZSCo <br /> 9. <br /> 10. 3--S s 1.\.s•� 1� r S�ccX �1 <br /> Specific Date Range of Information Requested-From Z���j to <br /> y / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> !W UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT O,SOuD WASTE FAciuTYNEHCLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) L7 F000 FAclurY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL C7 DAIRY <br /> ❑HAzARDOus WASTE GENERATOR O CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY C]rJIOTELINOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOGIBODY PIERCM ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PEROT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 9:00 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 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 riot 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 /> EHD4a-02-00s <br /> 1114103 <br />