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X1/2005 11:21 FAX 916 638 8385 DELTA ENVIRONMENTAL <br /> IA002/002 <br /> DA TE�,EqEFVED. <br /> END LOG NUMBER <br /> USAN JOAQUIN COUNTY <br /> ENviRoNmEENTAL HEALTH DEPARTMENT <br /> tknv - 304 East Weber Avenue,3rd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web. www.sigov.org/ehd <br /> 40a <br /> r ,i Ad <br /> _3 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: M;Wilt. kd9,ew5-- -. _BUSINESSIAGE14cy; Dof4ou6'V;904n1eA4fJ— <br /> ADDRESS: 31&q &DIA (Amy om'e, 1;4its 2ea, RAKahe, ftdoos &A 4600-41M <br /> PHONE(1): q1(f I%- 01,7q —PHONE(2); —FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE:_ 71me: q: <br /> (Please allow to business days from date of application submittal-*Teritaflve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-.s93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 11101174-6 <br /> UNIT DISTRIBUTION 0 Unit 1 13 Unit 2 &nit&XUnit 4 ]E Unit 5 13 Unit 6 C3 Other(electroalcillstsftnaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street Name city <br /> - 2. <br /> -3. <br /> 4. <br /> 6. <br /> 7. <br /> 8. <br /> 9, <br /> 10. <br /> Specific Date Range of Information Requested:From to FA,15 pj <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> &'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT E3 SOUD WASTE FACILITYfVEHICLE <br /> 13OTHER CLEANUP SITE(NON-LOP) IM FOOD FACILITY 0 WASTE TIRE <br /> ErUNDERGROUNo TANK(MoNrroFuxa/REmovAQ 0 Do(i KENNEL M DAIRY <br /> RrHA7ARDOUS WASTEGENERAToR 0 CHICKEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> E3 MEREE)PFRPAnTED FAculfY 0 MoTWHOTEL E3 PUMPER TRUCKIYARDICHEMTOILETS <br /> 0 TATToo/BoDy MERciNG E2 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 13 O`MVR(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERDdTREcoRias ARE AVAILABLE FM REVIEW- MONDAY-FRMAY 8:00 AM-S: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 typo MUST be selected. Fax to f2091464-0138 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 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 /> EHD 4M2-006 <br />