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01/23/2006 15:20 FAX 1 209 234 7727 STOCKTON 11001 DATE RECEIVED EHD 1_03 NUMBER SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 75 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 Telephone: (209)468-3420 Fax:(209)464-0138 Web: www.sjE,0r ehd 46 2��6 ,AN 23 Pik 3: PUBLIC RECORDS RELEASE APPLICATION 4, APPLICANT: V'� T,- C9(AbQG BUSINESS/AGENCY: �l?C1Ct eS jlR ADDRESS: 3110 IdA+ 110-4awler Sude c.1c1�- �, .lam oyt I GA t�R6 PHONE(1):e2OR)2-3L{`�Zl- PHONE(2)' 1g1b)STI—00555 FACSIMILE: �� 7 TENTATIVE*APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) CHECK BOX TO EXPEDITE REQUES 593.00 F (C OR HECK ONLY)-REQUEST PROCESSED INS BUSINESS DAYS SIGNATURE OF APPLICANT ALL DATE 2 O , UNIT DISTRIBUTION 13U 1 ❑ Unit 2 ❑Unit 3 13 Unit 4 13 Unit 5 C3 Unit B ❑ Other(electronic/I'Ists/maps) FILE ADDRESS EHD USE ONLY street iF Street Name _ city R-A L 2 3. 4. 6. _ �P 6. 7. _ - 8. 10. Specific Date Range of Information Requested:From to ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT M SOLID WASTE FACILrrY/VEHiCLE OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE ryU�NDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL 13 DAIRY PrHAZARDOUs WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS ❑TATr00/BODY PIERCING ❑POOLISPA M LAND USE APPLICATION SITES ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address indicated above. Address ranges will not be accepted-for additional assistance with file addresser.,contact the EHD.Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10)days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. EHD MI-02-004 1114MG