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09/25/2007 08;51 FAX 5307595E^° FEDEX KINKO'S DAUIS a OO2/003 <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 500 East Main Street, Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0I38 Web: www.sjgov.o hd (113 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �ri�`,' j - W hof BUSINESSIAGENCY. ebr15w� <br /> ADDRESS_—, 16 YLIf 'LCtL7� kut- _b,�wt6, C_A -9 �6'7e1(,3 <br /> PHONEW: (QO)7589�_7_PHONE(2): C536} 9192-063Z FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confl <br /> CHECK BOX TO EXPEDITE R QUEST-$98.00 FEE(CAS HECK ONLY)-REQUEST PROCESSED IN 3 S A <br /> NATURE OF APPLICANT _ RATE 2 <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 1S�treet Name City ❑ Unit 1 <br /> vwirs� RA <br /> 2. d DC, f i °40Lodi AID 2 g .3 .. <br /> 3. 2 �n l on oa� Sob od i 1di4 ` F_ < : A <br /> _.._ __ ❑ Unit 3 <br /> ❑ Unit 4 <br /> 7• E RCl'� <br /> OY Led-1 0 TO ❑ Ilnit5 <br /> g 1 1 1 1"oG � YC�m�+�`� �v 9 QUI 1 �?Js_ 9L-'� ❑ Unit s <br /> �0• E 4,r �,oe~e� Iv�9 1�od i %YI5 91-d 9 �A 9 7-LW <br /> Specific Date Range of Information Requested.From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ddgft <br /> UNDERGROUND TANK(UST)CLEANUP,SITE(LOP) Ci HOUSING MATEM ENT ❑SOLID WASTE FACT <br /> OTHER CLEANUP SITE(NON=LOP) n FOOD FACILITY 0 WASTE TIRE <br /> ❑UNDERGRoUNU TANK(MOHITORINGIREMOVAL) a K EL [3 DAIRY <br /> - El HAZARDOUS WASTE GENERATOR HCH 0 WASTEWATER TREA ENT LANT <br /> '0 TIERED PERMrrmD FACILITY EL 0 PUMPER TRUCK(YARDICHEN TOILETS <br /> El TATro01BODY PIERQNG PA )RU AND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY HER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT. 0 A AVAILA8LE FOR REVIEW -FAomoAY-FFuoAY 8:00 Am-5:OOPM -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 appropriate <br /> boxies). At least one file type MUST be selected. Fax to 12091464-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> - ----pays-aft.er recelpt-o a p kation:-T-he fi of s Iii be�eldiora inaZiffm-t of- ive--bustness-days#or-xeview.�ippointments.--:-__�---:--::—.-_- <br /> .ed_arc�acdiitQ _ <br /> 3. A Tile that is actively being worked on by EHD staff may not be Immediately available for review. A n�cation may be <br /> 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 applicant <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> END 4e-0e WEa &%2001 <br />