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JUN-08-2005 WED 03:04 PN SEnnR ARLINGTON TX FAX NO. 81- ,40 9149 P. 01/0 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY / <br /> DDC [EE VDD ENVIRONMENTAL HEALTH DEPARTMENT r <br /> 304 East Weber Avenue,3`°Floor, Stockton,CA 95202-2708 <br /> u 7005 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/chd o <br /> ENVIROi46iENT HEALTH PUBLIC RECORDS RELEASE APPLICATION �( <br /> AP LICA <br /> , i BUSINESSIAGENCY: 'O�" 1/L�l,Pl22_'hbY1 <br /> ADDRESS: 7730 SW Mohawk St TualaOn Oft 97082 (503)692-7074 <br /> PHONE(1): (503)691-2030 PHONE(2): FACSIMILE: !, <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Ploaee allow 10 buslnaea days from date of application submetal-`Tentative only-muet be confirmed) <br /> CI CHECK BOX TO EXPEDITE REQUEST-{80.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRI9UT10N GUnRi 0UnR2 nitd Una4 cIUITh6 ❑ UnhB Q Otlwr(alectronldlls�IRIRpa) <br /> FILE ADDRESS EHD USE ONLY <br /> Street III street Ramo Olt 1� <br /> 1. 251 IYArcy ParkwaY Lathro <br /> 4. <br /> 6. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> /'J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1RPUNDEROROUNO TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT Cl SOLID WASTE FACILIT/NEMCLE V <br /> TVOTHERCLEANO TSITE ANK <br /> t7 FOOD DOGKEN EL 13WASTETIRE <br /> NOERGROUND TANK(MONRORINOIRENOYAL) RDOG KENNEL ❑Da0.Y <br /> gNAZARDnu9 WASTE GENERATOR a CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> Cl TIERED PERMITTED FACILITY M MOTFLIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILeTs <br /> G TATTOOIBODY PIERCING n POOUSPA O LAND USE APPLNIATION SITM <br /> 17 MEDICAL WASTE FACILrrY C3 OTHER(PLEASE SPECIFY) <br /> WELL.AND SEPDC PERMrr RECORDS ARE AVAILABLE FOR Rmtw- MONDAY-FRIDAY 8:00 AM-8:00PM - ExCLUGING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)Of TIES from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 209 464-013B or mall to the addreas <br /> in Gated Bove. 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 aAny pplicant. Futurefi enot returned ievlews by the sahe same tion as me applicant may require a leased will be 5931zed 00 deposit prior to reeviewponse of the <br /> eHo u-oa.00c <br /> v++roe <br />