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fJ F:e4/26/2005 21:16 20936e'- -58 " STEPHEN G.MUIPAGE 04/04 <br /> i <br /> }r DATE REGEII/EIJ. SAN JOAQLTIN COUHT�' EHU LOG NUMBER <br /> ENVIRONMENTAL HEALTH DFPARTMENT <br /> r 304 East Weber.Avenue, 3''4 Moor, Stockton,CA 95202-2708 <br /> 'pt leplxone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov_Org/ehd <br /> I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT .:S r rweK/_ V!iC .�^ ^BUSINESS/AGENCY: <br /> ADDRESS: a ;3o X i5 W�Ab y2/b6- _� _9-0;2_ g <br /> PHONE(1):_Z0 - 306_ `/ 7 PHONE(2): (0 9 FACSIMILE' Zo�- <br /> d{ TENTATIVE*APPOIMMENT DATE: 57a 'rime• <br /> {Please anow 10 business days from dot of APPROation submittal--remmilve only-muet be canfirMeM <br /> �] CHECK 13Ox TO ExPEDrrE REQ ST493.00 593.00 FEE(CASH OR CHECK ONLY)-REOUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 6 , DATE <br /> A71657- <br /> 'I <br /> I <br /> UM- T DISTIRIeUTION 13 unit 1 O unlit 2 b Unit 3 ❑ Unit 4 o Unit 6 0 unit 6 In Other(eleetronicnistsimsps) <br /> FILE ADDRESS EHD USE ONLY <br /> tf Street# Street Flame' City <br /> 2- d R! IA1a Al terra e/:� l /�"rp ON <br /> 3. �•i r e r aL� �S*�1 fort Fad' M�' <br /> �J b. <br /> 7. <br /> 10. <br /> i Specific Date Range a r lefamuticn IRaque$W:From to C U or/-e-7- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> fl UNIMOROUND TANK(UST)CLEANUP SITE(LOP) 31. HOUSING;A9ATMGNT 0 SOLD WASTE FACILIT//VCHICLE <br /> OTHEx C;-rANup SITE(NoN4.OP) I 0 FOOD FACILM ©WASTE TIRE <br /> j p l NDMROUND TANK(MONrrofUNG1REMOYAL) O Dao KENNEL d DAIRY <br /> O HAZARDOUS WASTE C�ENa tATOn 0 CHICKEN RANCH Q WASTEWAtim TREATMW PLANT <br /> l 7tEREG PEIIMITTEp FAC[LPrY 15 ©PLWPER TRUCKIYARDICHEM TOILETS <br /> fl TATTOOlBODY PIERCING ra POOLISPA M LAND Use APPLICATION SITE$ <br /> 0 MEDICAL WASTE FACILITY Ia armim(PLEASE SAl g ly <br /> WE LL AND SEPTIC PERMIT RECORDS ARE AVAILAOLZPoRREvILw. MONDAYFRIDAYS:00 AM-6:00PM - Eak:l kAMO HOUDAYa. - <br /> i. List up to tort addresses In the space above. Select the type(5)of tiles from the list above by checking the <br /> appropriate box(es). At least 000 file type MUST be selected. fax to(.2-91.464-01P8 or mail to Ow address <br /> 1ndICat&0 above. Address ranges will not be a0cepled-.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 an EHD files exist. <br /> Y Ana ntma�rt far review will 111 be confirmed <br /> approximately ten(10)days after receipt of application. The files wilt 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 /> applicatlon may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 depositprior t0 review. <br /> 1 _ <br /> a�ssazaoe <br /> IRA= ! <br /> I. it <br /> i <br /> 9 <br /> I: <br />