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166123/2005 14:03 916-371-1809 RANEY GEOTECHNIQAL PAGE 01/0 <br /> .� `ter• <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENvmoNMENI'A.L HEALTH DEPARTMFENT go <br /> Ya ,.% <br /> 304 East Weber Avetme,3 Floor, Stockton,CA.95202-2708 200 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd5 JUN 23 pH '3: <br /> SAN <br /> PUBLIC RECORDS RELEASE APPLICATION n tjt,,, C00ti7- <br /> APPLICANT: /7 �' , BUSINESSIAGENCY: <br /> ADDRESS: 3�4�a ,/� / <br /> PHONE(1)-pliy.57/'--<4 T 5 7 PHONE(2); FACS4MII E� 7f" Q_ <br /> TENTATIVE*APPOINTMENT DATE: Time:_ <br /> (Please allow 10 business days from date of appiicMIon submittal-'Testa"only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST- . 0 ' HECK ONLY)-REQUEST PROCESSED 1N 3 USINE DAYS Z� <br /> SIGNATURE OF APPLICANT DATE S <br /> UNR DISTRIeUT10N O Unit 7 nit 2 UnI nit 4 Unit 5 17 Unit 6 ❑ Other(eleetronlcAlats/maps) <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 3 <br /> s _ , <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES " <br /> UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) ❑HOUSING ABATEMENT ❑.SOLID WASTE FACILITYIYEHICLE <br /> OTHER CLEANUP Sat(NON-LOP) 0 FOOD FACIl.tT1' Q WASTE TIRE <br /> ❑UNDERGROUND TANK(MONrTORINOIREMOVAL) 0 Doe KENNEL 0 DAIRY <br /> JR HAZARDOUS WASTE GENeRATOR ❑CHICKEN RANCH )CWASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FAcILrTY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> 0 TATrooftDY PIERCING la POOL/SPA Q LAND USE APPLICATION SnEs <br /> 0 MEDICAL WAarr FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - EKCLUDING HOLIDAYS. <br /> 1. List up to teen addresses In the space above. Select the types)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be s6lected. Fax to(209)464-0138 or 0411 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 IsHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ton(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 F-HD staff at the expense of the <br /> applicanR. Future file reviews by the same applicant may require a$9,3.00 deposit prior to review. <br /> END 4Q-02-006 <br /> RUSH711MOs <br />