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02/13/2006 10:32 FAX Z002/002 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENv>tRoNMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, P Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ohd 7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � BUSINESSIAGENCY: LLZ24[prl <br /> ADDRESS: Z��a�AC . M`�P T(-- S�T CITY agLr_ O _STATE_�Q_ <br /> PHONE(1): Z A-�' 1—�d r PHONE(2): FACSIMILE:-UP— q Y�'-fib Z,I <br /> TENTATIVE`APPOINTMENT DATE: 7,12--7 l0 t., Time: <br /> (Please&flow 10 business days from date of appllcatlon submf W-*Tentaflve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE PEQ sT- 83.00 F (CAS OR CHECK ONLY)-REQUEST PROCESSED IN S BUSTNE S DAYS <br /> SIGNATURE OF APPLICANT , DATE Z—/['<ZD(j <br /> Electronic ❑ ust ❑ Map-Descrtptlon <br /> Information <br /> FILL=ADDRESS EHD USE ONLY <br /> Streett Street Name City <br /> 1. ?y ❑ Unit 1 <br /> 2. Dc <br /> 3. /- "Unit 2 <br /> 4. <br /> 51 4!r Unit 3 <br /> 6. ov Unit 4 <br /> 7. <br /> 8. ❑ Unit 5 <br /> s. <br /> 10. ❑ Unit <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �NOERGROUND TANK(UST)CLEANUP SrTE(LOP) ❑HOUSING ABATEMENT O SOLID WASTE FACIUTYMMCLE <br /> THER CLEANUP SrTE(NON-LOP) 11C3FooD FACU Y WASTE TIRE <br /> UNDERGROUND <br /> MC TA (MOWTORINWREMOVAL) C7 DOG KENNEL �9AIRY <br /> AZARDOUS WASTE GENERATOR ❑OFn mm RAN" WASItWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACwTY ❑MOTELIHOTEL ❑PuuPeR TRUCKIYARDICmE&WAL ToILETs <br /> 10 TATTOOIBODY PIERCING ❑PMJSPA ❑LAND USE APKxAT10N Sms <br /> CO MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERIUT IZ900"S ARE AVAr."LE FOR REVIEW-MONDAY-FRIDAY 8:00 Am-5:00pm - EXCLUDING HOLIDAYS, <br /> tt <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 /> `�Upproprlate box(es), At least one file type MUST be selected. Fax to(209)4640138 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 fife 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 /> EFID 4B-0{ <br /> �aa1l2906 <br />