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12/30/2005 08:11 FAX 510 420 9?•'1 CAMBRIA d 001 <br /> Ung G nCt.GtVCU <br /> <� SAN JOAQUIN COUNTY �L� END LOG NUMBER <br /> M i ��L �D ENVIRONMENTAL HEALTH DEPARTMENT <br /> nL �`J 304 East Weber Avenue,3`a Floor, Stockton,CA 95202-2708 <br /> Ute. LOu� Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd 62 5,30 <br /> r HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> API1l 6I BUSINESS/AGENCY: � B2��1 �.ur/i,COAl u�iyr f� <br /> ADDRESS 5-940 64/�6 .Sly .Svi7,�J4 �.cl6�d✓ic�c �'/� 91V4 on <br /> PHONE(1): S/o VZO ,ate-Cy PHONE(2): <br /> `/ FACSIMILE: $7 � <br /> 0 � _ pi,7� <br /> TENTATIVE*APPOINTMENT DATE:.1Ao'& q, 200 Co Time:0?cw> <br /> (Please allow 10 business days from date of application-submittal-"Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITER VEST-$930,0 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT t, ,& DATE <br /> `---- DATE z.,�, — <br /> 5 <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑Unit 3 ❑Unit 4 ❑Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 1. 2'320 <br /> 2. i5I S E �oe s Sra .c/ 33. <br /> 4. <br /> 5. <br /> 6. <br /> 17. <br /> 8. <br /> 10. <br /> Specific Date Range of Information Requested:From -,44 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILTrYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ID CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MoTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING O POOL/SPA ❑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-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 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 /> r. <br /> EHD 48.02-006 <br /> V14105 <br />