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12/30/2005 08:11 FAX 510 420 9lR" CAMBRIA - wool <br /> vnt nr=�.cry to EHD LOG NUMBER <br /> rt SAN JOAQUIN COUNTY' <br /> p ENVIRONMENTAL HEALTH DEPARTMENT , <br /> 304 East Weber Avenue,Yd Floor, Stockton, CA 95202.2708 <br /> Ur. , 0 Nn Telephone: (209)468-3420 Fax: (209}464-0I38 Web: www.sjgov.org/ehd 153o <br /> T �iEALW { PUBLIC RECORDS RELEASE APPLICATION <br /> it API�i� I BUSINESSIAGENCY: djw� [tir,Cdicic/ at/ L <br /> AbDRESS: qo aL� ami .Simi .� �.�! ✓� �T 4�l�a$ <br /> PHONE2; <br /> ( } FACSIMILE: <br /> TENTATIVE*,APPOINTMENT DATE:,A�e&_I, !.S too Cv Ttme:O9 <br /> 11 (Please all iw 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK 80X TO EXPEDITE REqUEST-; 00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z1n5,riee7c ao, <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronicllists/maps) <br /> FILE ADDRESS <br /> Street# 5treet Name ,i city EHD USE ONLY <br /> 3- <br /> [4 <br /> . 23xo JE � ,e ' r 3t�cJ <br /> n RLI <br /> 2. 2s rs E aa� 5'ro ,y 3 <br /> 4. ; <br /> I 5. n <br /> /. <br /> 10. <br /> 1_ f <br /> f. Specific Date Range of information requested:From 1� :I <br /> to <br /> ij <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ' <br /> NDERGROUND TANK(UST)CLtEANUP SITE(LOP) El HousING A9ATCMExT <br /> 050LID WASTE FACILTIYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) i O FOOD FACILrrY ❑WASTE TIRE <br /> XUNDERGROUNDTANK(MONITORINGIREMovAL) ❑Doe KENNEL. i7 DAIRY <br /> A HAZARDOUS WASTE GENERATOR .CHICKEN RANCH L7 WASTEWATER TREATmsWr PLANT <br /> t L7 TiEREDPERNITTEDFAciuTy ©MOTELr1i0TEL ❑PUMFERTRUCKIYARDICHEmTofLETS <br /> 13 TATTooMooY PIERCING C1 POOLISPA 17 LAND USE APPLICATION SITES <br /> 13MEDICAL WASTE FACILITY d OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT REcoRos ARE AVAILA9L3 FOR RE Fw- MONDAY-FRIDAY 6:00 AM-5:00pM • EXCLUDING HOLIDAYS. <br /> 1. !List up to ten addresses in the space above.:Select the type($)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 I;HD 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 /> j 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 whenithe 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 /> ------------ <br /> F F IJ <br /> EHD 48-02.006 a <br />