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MAR.10.2005 10:59AN APc-" ENVIROTECH,INC. NO.289 P.1 <br /> DATE RECEIVED EMD LOG NUMBER � <br /> SAN JOAQUIN COUN'T'Y <br /> REOVED ENVIRONMENTAL HEALTH DEPARTMENT � <br /> 304 East WfI ber Avenue, 3 Floor, Stockton, CA 95202-2708 <br /> MAR I 0 2005 Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd <br /> ViRQHWHT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> A T: <br /> BUSINESSIAGENCY; k <br /> ADDRESS:PHONE(1):�i'bt L�o� � �Z PHONE(2): ��T L� Cab FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: UAa*�k ��� 7-�� —Time: CA, <br /> (Please allow 10 business days from data of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK EOX TO EXPEDITE REQUEST.$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 t4 O t <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3, Unit 4 j9drilt 5 ❑ Unit 6 Cl Other(slactroniollistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> $treat# Street Name City <br /> urd" lKt <br /> 3. 4 ooli�,o� SF�acu �. z. T--w) <br /> 6. Ci l <br /> 7. <br /> 9. �l3y � e5 <br /> 110. <br /> Specific Date Range of Information Requested: From to � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> YUNOERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT A SoFID WASTE FACaMNEHICL12 <br /> C OTHER CL>;ANUp SITE(NON-LOP) <br /> ❑FOOD FACILITY ❑WASTE TIRE <br /> M UND"nROUNOTANK(MoNITOR(NGIREMOVAL) ❑DOG KENNEL ' ❑DAIRY <br /> ❑HAuRDOUs WASTE GENERATOR Q CHICKEN RANCH A WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY <br /> ❑M07EL1H07EL ❑PLjMPER TRUCKIYARDICHEM TOILETS <br /> *TATTOOIBODY PIERCING 0 POOLISPA Cl LAND USE APPLICATION S(TES <br /> ❑MEDICAL WASTE FACILITY M OTHHR(PLEASESPECIFI� <br /> WELLAND SEFnC PERMIT REMORAS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 9:00 AM-5:00PM - 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 fiie type MUST be selected. Fax to 209 4640138 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 /> • II <br /> EHo 4a.oz aaa <br /> 1114105 <br />