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06/ 01 / 2005 17 : 35 530676 05 STRATUS NO CAL.T� PAGE 01 / 0 <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenge, 3'' Floor, Stockton, CA 9520 �$g7'� t� <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwwsol$/ LI P� ,�1 r <br /> PUBLIC RECORm RELEASE APPLICAT � ul ' UZAL y <br /> / } � 11 BUSINESSIAGENCY: Tt� ENT , <br /> APPLICANT: l- ^ •- • � I KO%.l�hr <br /> ADDRESS: 6rVU '^'� 550� <br /> PHONE (1): (G3w ro - b(Q ) PHONE (2): 530 - FACSIMI- L _ — <br /> TENTATIVE* APPOINTMENT DAT Ima //�/•'_�/, ji <br /> (Please allow 10 business day t �p n sub - •Y only - must be confirmed) <br /> l� CHECK BOX TO EXPEDITE REQUEST 93.00FE CASH O CHEC DNCYt - QUEST PROCESSED IN 3 6USI N S$ DAYS / <br /> SIGNATURE OF APPLICANT DATE G O lL <br /> UNIT DISTRIBUTION ❑ Unit 1 r[7 Unit 2 O Unit 3 0 Unit4 Q Unit 5 O Unit 6 0 Other (electronidlistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> $treat0 Street Name city <br /> 2. <br /> 3. tt <br /> 4. 2 <br /> 5. <br /> 7. <br /> 8. <br /> 9. <br /> 10. ELL <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESW�I - <br /> NDERGROUNDTANK (UST) CLEANUP SITE (LOP) V HOUSING ABATEMENT C3SOLID WASTE FACILrrY1VEHICLE <br /> 10 OTHER CLEANUP SITE (NON-LOP) 0 FOOD FACILITY OWASTE TIRE <br /> ® NDERGROUND TAW (MONITORINGIREMOVAL) MOGG KENNEL 11 DAIRY <br /> arHAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH O WASTEWATERTREAmENT PLANT <br /> O TIERED PEItMTTEO FACL ❑ MoTEIHOTEL 0 PUMPER TRUCK/YARO/CHEMTOILETs <br /> 13 TAYYOOIBODY PIERCING 0 PCOLISPA 171 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACIUTY O OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIOAY S!00 AM5:00PM - EItcLUDINGHOLIDAYS- <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 (2091404 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 /> IND4042-00s <br /> tllNSs <br />