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05/2612007 16:30 209-9435 WELLS FARGO BAN k <br />PAGE 01101 <br />DATE RECEIVED EHD L03 NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 E. Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3421) Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION . <br />APPLICANT' =rM IF S 4. <br />.r w a BUSWESS/AGtNICY: 0)1FddFAjC4 b *jjiI^+ k - <br />ADDRESS: n3 !� . �,`"I �rZ.•f � '�. f o k moo.,] C14 has <br />PIfONE (1):"fSf+ PHONE (2i:. `� tb.o'� 4f? FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 74'business days from date of application submittal TWMOva only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST, " 0 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE1;✓Z. <br />Electronic Information. ❑ List [j Map— Description: <br />to <br />FILE ADDRESS <br />EHD'USE ONLY <br />IFF.UNDEtaGRDUND TANK (UST) CLEANUP gin (LOP) 0 HOUSING AaAmmENT <br />street # <br />Street Name Clt <br />Q Unit 1 <br />a, <br />M DAIRY <br />❑ HAZARDOUS WASTE QENERATOR In CHICKEN RANCH <br />p unit z <br />❑ TIERED PERMITTED FACILITY l7 MOTELIHOTEL <br />0 PuMPEFt TRUCKJYARDICHEM TOILETS <br />❑ TATFOOIBOOY PIERCING ❑ POOLISPA <br />Unit 3 <br />d. <br />Wr;L r. AND SEPnC PERMIT RECORDS ARE AyAiLA$LE FOR REVIEW -_ MONDAY-FRibAY 8:04 AM-6:OOPM - PxCLUDIN6HOLIDAYS. <br />a Unit 4 <br />6. <br />7. <br />_. <br />© Unit <br />8. <br />9. <br />© Units <br />10. <br />Specific Date Range of information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />FILES <br />IFF.UNDEtaGRDUND TANK (UST) CLEANUP gin (LOP) 0 HOUSING AaAmmENT <br />❑ Souo WASTE FACR-ITYMEHICL.E <br />GrOTHER CLEANUP Sn-E (NON -LOP) 0 FOOD FACILiTr <br />0 WASTE TIRE <br />12'UNDERGROUND TANK (MCNITDRINGIRMNAL) ❑ Doo KENNEL <br />M DAIRY <br />❑ HAZARDOUS WASTE QENERATOR In CHICKEN RANCH <br />M WASTEWATER TREATMENY PLANT <br />❑ TIERED PERMITTED FACILITY l7 MOTELIHOTEL <br />0 PuMPEFt TRUCKJYARDICHEM TOILETS <br />❑ TATFOOIBOOY PIERCING ❑ POOLISPA <br />D LAND USM? APPLICATION SMS <br />© MEDICAL WASTE FACILITY 0 OTHER (F LEASESPEGIFY) <br />Wr;L r. AND SEPnC PERMIT RECORDS ARE AyAiLA$LE FOR REVIEW -_ MONDAY-FRibAY 8:04 AM-6:OOPM - PxCLUDIN6HOLIDAYS. <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate <br />bcx(as). At least one file type MUST be selected. Fax Yo_ (-ZQS) 464-0138 or mai) to the address indicated_aboye,, Address <br />ranges will not be accepted — for additional assistance with file addresses, contact the EHD. Applications received after <br />8:00 pm will be processed the next business day. <br />Z.' The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The files will beheld for a.rltaximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />3.' A file that Is actively being worked on by EHD staff may not be Immediately available, for revlew. A new application may be <br />submitted when the fire 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 applicant. <br />Future file reviews by the same applicant may require a $95.00 deposit prior to review, <br />EHD USE ONLY <br />4E.06 BV1112f106 wen - - - <br />