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Dec. 8. 2005 2:28PM Adv -ced GeoEnvirenmenta iVo. 3195 �. 1 <br /> EHD LOG NUMBER <br /> o �T ti� ` � D SAN JOAQUIN COUNTY <br /> rul <br /> IENVrRONMENTAL TUALT'H D EPAI€ IMENT .� <br /> DEL, - 304 East Weber Avenue, 3`6 Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fox;(209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIR - � i H <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Suzanne Henderson BUSINE35lAGENCY: Advanced n <br /> ADDRESS: 837 Shaw Road,Stockton,CA 95215 <br /> PHONE(1). 209-467-1006 PHONE(2): Cell:209-712-2278 FACStMIvur'r do <br /> 1 <br /> TENTATIVE"APPOINTMENT DATE. Time: <br /> (Please Olow 10 business days from date of appik"on submittal-'1 erttaUvr only-must be canflrmeA) <br /> CHECK BOX TO EXPEDITE RE , T-$94.00 FEE( H OR fiCK ONLY)-REQUEST PROCESSED IN 5 Su INE DAYS <br /> SIGNATURE OF APPLICANT DATE d- <br /> UN[T DISTRlr3UT10H ❑ unit 16nit 2 j6nit3 96nit4 O Unit 5 4 Unit 5 ❑ Other(eieCtroniCAistslmaP4) � <br /> FILE ADDRESS EHD USE ONL 1}� <br /> Street* Street Name City <br /> 2. 3 <br /> 3. L / C 9 to- <br /> 4. 5 6q <br /> (/- 11/4 rn <br /> b6S) <br /> �: U 'LU <br /> 7. 111 L <br /> B. <br /> s. - <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I JI <br /> X UNDERGROUND TANK(UST)CLEAKUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FAaUTWERCLE CA,9 OTHER CLEANUP 8ITE(NON-LAP) ❑FOOD FACIUTY ❑WASTETIRJ M UNDERGROUNDTANK(MoNfTORINCfFEMOYAL) ❑DOG KENNEL ❑DAIRY <br /> P HAZARDpt1S WASTE GENERATOR ❑CHICKEN RANCH d wASTf_WATER TREATuFNT PLANT 1 <br /> •TIERED PFRmiTTEo FACIUTv ❑MoTELh{oTEL ti PUMPERTRjjcK[YARWCI{EM TOItET$ <br /> •TATTooIBODY PIERaNG ❑POOLlSPA IO ukNo USP.APPUCAMN SITES <br /> C3 MEDICAL WASTE FACILITY 11 OTHER(PLEA$E SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 5:00 AM-5:WPM _ FXCLUU4MG HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(S)of SIBS from the list above by checking the <br /> t one fele MUST be selected. Fax to 209 464-0138 or mail to the address <br /> appropriate box(es). At leas tyre � 1 <br /> ind)cated above._ Address ranges will not be accepted—for additional assistance with file addresses,contact p J <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. D <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately tett(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$83.04 deposit prior to review. <br /> trlD�a ax-0ae <br /> 7Md196 <br />