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02/13/2006 10:32 FAX Z002/002 <br /> DATE RECEIVED EHD 0G NUMBER JOAQUII+1 COUNTY <br /> EwiRoNMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ohd <br /> PUBLIC RECORDS RELEASE APPLICATION 7 <br /> APPLICANT: p BUSINESSIAGENCY: <br /> ADDRESS: �V �a� C M`I PSL-1�' S( CITY OC _STATE-C_ <br /> PHONE(1): Z ~ 1- �J r PHONE(2): FACSIMILE. <br /> TENTATIVE`APPOINTMENT DATE: 7,1 2,:7 ZD U Time: <br /> (Please&flow 10 business days from date of application submfttal-`Tenta!!ve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ ST- 83.00;=CHECK ONLY)-REQUEST PROCESSED INS BUSINEE S DAYS <br /> SIGNATURE OF APPLICANT DATE x(,15)_ <br /> LElectronic ❑ Ust ❑ Map-Dsacriptlon <br /> Information - <br /> I <br /> FILL=ADDRESS EHD USE ONLY <br /> IStrrret Street Name fifty ( <br /> F2. <br /> �,, Q Unit 1 <br /> ci. <br /> 3. 00* Unit 2 <br /> . <br /> 4 <br /> 4. r Unit 3 Z <br /> 6. Unit 4 <br /> 7. <br /> S. ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .pNOERGROUND TANK(UST)CLEAmup SrrE(LOP) ❑HouslNG AsATEMFNT O SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP BrTE(NON-LOF) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND <br /> NK TA (MONITORINGJRrmovAL) Q DOG KENNEL X�QWRY <br /> Al2ARvous WASTE GENERATOR ❑Cmmx EN RANT-H WASTEWATER TREATMENT PLANT <br /> ❑TIEREP PERMMED FACILITY ❑MoTaUHOTEL ❑PvmP R TRUCKNARDICHEmiCAL ToILETB <br /> 0 TATTOPIBODY PIERCING ❑POWSPA LANG USE APPUCATION STIES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)WELL AND SEPTIC PERma REcORbs ARE AVAILABLE FOR REVIEW-MONDAY-FRX)AY 6:00 Am-5:00PM - EXGLVDING HOUDAM <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by chec}:Ing the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)4640138 or mail to the address <br /> Indicated abovo. 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 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 /> j <br /> EHD AB-0{ <br /> twat72o06 <br />