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—r?!_n-1/2005 11:21 FAX 916 638 83R5 DELTA EIWIRONMENTAL Q002/002 DATE RECEIVED EHD LOG NUMBER A1 (( 'r SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd a a rAI :,iif;r;hn PUBLIC RECORDS RELEASE APPLICATION) / ''` APPLICANT: I�Ii�fwl k lzfwS t BUSINESSIAGENCY: '9e,14A- 61y;9omr I eA+0_ ADDRESS: 11&4 6,01 (,AYO'y R1r,it, SMitf 2a0, RAje v Cl oyA-, &A 000-G014 PHONE(1): 114 43$- 01'7q PHONE(2): ` FACSIMILE: TENTATIVE`APPOINTMENT DATE: III 14 I ZOb� Time: q.3o (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) C] CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE III Zia S UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 &nIt Unit 4 Unit 5 ❑ Unit 6 ❑ Other(electronWists/maps) FILE ADDRESS END USE ONLY / Street# Street Name city ✓ ✓ 1• Z'316" �QIvnI�nrL. too �. i11[r i�°C/ 3. 4. s. 1 6. 7. s. - 9. 10. ILL 1 1 Specific Date Range of Information Requested:From �$Y to PfLCSert,, �/ ENVIRONMENTAL HEALTH DEPARTMENT FILES Id UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FAGLrYNEHICLE ❑ OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE dUNDERGROUND TANK(MONrroRINOIREMOVAL) ❑DOG KENNEL 0 DAIRY V'HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT ❑TIERED PERMITTED FACILITY ❑MoTmJHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS C7 TAT-Too/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES ❑MEDICAL WASTE FACILITY El OTHER(PLEASE SPECIFY) WELL AND SEPTIC PERmrT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM5:OOPM - 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(209)464-0138 or mail to the address indicated above. Address ranges will not be accepted—for additional assistance with file addresses,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 48-02.006 1/14!05