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Apr 1$-05--04:46p Drew Van Aller 20°'367-9668 p.1 <br /> � � w <br /> U � li U JJ <br /> DATE RECEIVED EHD LOG NUMB <br /> APR - :) ?005 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENIV;F,,0WAEIsIT i-'-,;!_r0 304 East Weber Avenue,3'd Floor,Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)46"138 Web:www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> L7 reLi �� A t r 1'"t ;-p BUSINESS/AGENCY: A _ - <br /> �x <br /> ADDRESS: <br /> ^� C <br /> PHONE(1): (D(o T ��'�`i PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: 5 3 Jos Time: CyiQD <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> C3 CHECK BOX TO EXPEDITE REQUEST,-x$93.00 FEE(CASH O CHECK ONLY)-REQUEST PROCESSED IN 3BUSINESS DAYS <br /> SIGNATURE OF APPLICANT t]J'.ra DATE q(r I'61 Q 5- <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑Unit 2 t7 Ulf 3 Unit if 17 Unit 5 0 Unit 6 ❑ Other(electronicilistsimaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street* Street Name City <br /> 1. Crvnvtl��c i rn c <br /> 2 3 trlc. c.�low S CK ill <br /> 3. ,yJ 7 %✓✓j�j''JJ <br /> 4. i Lco e, l�a�,uw Lr3w s a t1�1 <br /> 6. o2fr <br /> 7. (SG 1 <br /> 8. Z5Z0 "1 4 owzl <br /> 9. 'N I 45 4t A-oO <br /> 10. 31-55 1 &%,34 t. SaracX n <br /> Specific Date Range of Information Requested:From ZC�C--3 to `LAS tJd 'i►I <br /> ,/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ?W UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 13 SOLID WASTE FAcIUTY1VEHCLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) 13 F000 FACILITY 17 WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREWWAL) ❑DOG KENNEL 0 DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERInTTED FAciLnY D MOTEL/HOTEL E7 PUMPER TRuCK/YARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA C7 LAND USE APPLICAMN SITES <br /> 13 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 9:00 AM-5.00PM - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0738 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the END.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 /> snD.aaz.00s <br /> vwos <br />