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04/11/2006 21:06 9494293' ESS PAGE 02 <br /> EHD LOG NUMBER <br /> Mlf& <br /> SAN JOAQUIN COUNTY <br /> ENVIiRONMI;NTiAL HEALTH DEiPARTME1w1T <br /> `:; 9, k 0006 304 East Weber Avenue,3`1 Floor,Stocton,CA 952422709 <br /> Telephone: (2it9)469-3420 Fax: (209)464-0138 Web.www.sjgoe.(rglel�d <br /> Ef3VjRo l.dMU4T HEAJH <br /> PERP MSER\JIGES PUBLIC RECORDS RELEASE APPLICATION <br /> giJSINESSfAG1"A1CY• /�iJ��fr`n/tim ,.5 ��^u/c� <br /> APPLICANT: zoo <br /> -� <br /> ADDRESS: FACSiw T <br /> PHONE(1):� ���PHONE(2): <br /> Time: <br /> TENTATIV0 APPOINTMENT DATE: <br /> (Pleaaaaw io bualness days from data of application submittal•"Tentadve only-must be°dn�n"odl <br /> d <br /> IM CHECi:BOX TD 6XPEDriE REQUEST•y93.00 FEE tCASH OR CHECK ONLY)-REOUF._ST QROCESSEQ IN 3 gUS1NESS DAYS <br /> SIGNATURE OF APPLICANT iDATE <br /> uNIT DiSTRIBU TION D unit 1 <br /> ❑unit 2 ❑UnPt 8 ❑Untt b d Unik S Ci Units 13 Other(liectronicllistsimapx) <br /> Fll_�ADDRESS ___ EMQ USi=ONLY <br /> F3. ._.. StreeR# - Street Name -- _---__ — --- <br /> 3. <br /> City <br /> T. <br /> 4 Q. <br /> Specific Crate Range of Information Requested:F'roi n ._ to <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILES <br /> Ma SINDEROROUND TANK(UST)CLEANUP STrE(LOP) CI HOUsiNG ABATEMENT ❑SOLID WASTF FACiL"tVEi'tICLE <br /> �ER CLEANUP SITE(NON4-OP) ❑FOOD FACILITY � TSE <br /> UNDERGROUND TANK(MONMOR1NG1REMOYAQ) ❑DOG K>r1VNEl DAIRY <br /> HAZAT+DOU9 WASTE GEMPATOR ❑CHICKEN RANCH ❑WASTEMIATER TR5NYM1 Tit PLANT <br /> C3 TIERED PER111r720 FACk" ❑MOTFJJHOTEL G PUMPER TRUCKrfA*toic r;MTOILETS <br /> ❑TATroofso0Y P19mc ❑POOLISPA ❑LAw Use APPLICAMON tMEa <br /> ❑MEDICAL WASTE FAe Ln'Y Ia OTHER(PLFArm SPEct Y) <br /> WELL AND SSMC PERF41T RECORDS ARE AVALLABI.E Port REViEW- MONDAY-PRiDAY 8:00 AM'O;OOPM - ECCLUDIN6 HOLIDAYS. <br /> 7. 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)A§AA13$or MgMa the addms <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 avallable for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the some condition as released will be reorganized by EHD staff at tho expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EttD tiBaaaa6 <br /> • i119�s <br />