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01/24/2005 15:34 CLAY—',I GROUP 4 12094640138 NO.839 90 <br /> A A.A w%)QUI N.NVIRONMENTAL t JH PAGE 0ri 1 <br /> Nwe <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> -- <br /> MECE %4ED ENVIRONMENTAL HEAD,"MPARTMENT <br /> IN 304 East Weber �( <br /> - Avenue,- �rd x'100r,Stockton CA 95202-2708 -_- <br /> i 2 A gong Telephone:(209)468-3420 Fax! (209)464-013&Web:www.sjgov.orZ/ehd <br /> ENMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> Pg BUSINE$S(AGENCY: <br /> ADDRESS: •2 <br /> PHONE(1): fly .fib g PHONE(2): 2-0 <br /> O Y FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time. <br /> `� �� (please allow 10 businoss days from date of�pgllCatian sub+ritiai-'Tonfative only-must be confirmed)1 V q_J b� U/CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASM OR CHECK ONLY)-REQUEST PROCESS90 iN 3 BUSINESS DAYS <br /> SIGNATVR',OF APPLICANT DATE <br /> UNIT DISTRI>3Unit 5 G Units q Other(clectronlcJlistslmeps) <br /> UTIUN o unit i Unit 2 Unit 3 Unit 4 <br /> FILE ADDRESS 'J EHo USE ONLY <br /> Street p street Name GI — <br /> t <br /> z. a5�o wr�r mow C- <br /> 1 <br /> sie <br /> 4. <br /> 7. <br /> 6. <br /> �o. I <br /> ,. <br /> 8peciflo Date Range of Information Requested:'From 10 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q HCuswo ABATEMENT O SOLID WASTE PACIUTYTVF OCLE <br /> $rtJNDERGaoucro LANK NSA CL£ANup SITE(LOP) r3 Foot)FAC%r Y O WASY>E TIRE <br /> 0-01-HER CLEANUP SITE(NON-LOP) ❑po0 KENNEL 0.,,DSAIIRY <br /> M'ITNDEROROUNG TANK(MONITOaINWREMOVAL) 12 CHICKEN RANCH V WASTEWATER TREATMENT PLANT <br /> ZnAZARDWS WASTE GENERATOA fl CHICK N RAN 0 PUMPI=ft'TRVCKIYARD/CHCM TOIL:T3 <br /> 01-TIFRED PERMITTED FACILITY ❑POOL/SPATELIHO ❑ LAND 118E APPticaTION SITES <br /> O TATTOO/FZODY PIERCING Q OTHER(PLEASE SPeC1Fa7 <br /> 0 MFmCAL WASTE FACILITY <br /> WELL AN4 SEPTIC PER1d1iT RECORDS ARE AVAILASI.E fOR REVIEW- MONDAY-FRIDAY f):80 AM-S:OaF`AM EXCLUDING Dui <br /> 1. Llst up tO ton addresses in the space above. Select the typ°(s)MUST be solected, of files from the list above by checking the <br /> appropriate ove, ). At least one sS ran eS filetype <br /> not be accept d-for additional assistance tance with file addressesor mail to the {contact <br /> 64-013 <br /> indicated above.. Add reSS 9 <br /> the EHD.Applications received after 3:00 pm will be processed the next business day <br /> 2. The END 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. Appolntmente 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 avallable. <br /> 4. Any file not returned in the same condition as released will be teorganized by EHU staff at the expense of the <br /> applicant- Future fate reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END 4e.mnos <br /> yti:Lro� <br />