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DATE Feb, 10- 2006 11 :28AM A( vanced GeoEnvironmental No. 3878E�D�,,.1,JUMB�R <br /> � <br /> ° E uU E� ENVIRONMENTAL SAN JOAQUtN'COUNTY �E ONMENTAL HEALTH DEPARTMENT <br /> 0006 304 East Weber Avenue,3rd Floor, Stockton, CA 95202-2708 <br /> FEB 0 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONPAEi'T HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: U h 60 BUSINESSIAGENCY: V y%w AM. <br /> ADDRESS: 11J D QSI-0 04 q t <br /> PHONE(1): D q- yrs 7•/100 6 PHONE(2): G ^ '7 FACSIMILE: p Q 7 - 7 -1I 1 <br /> TENTATIVE"APPOINTMENT DATE: a /Jr Time; ZQ:o l <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE T-$93.00 FEE(C OR HECK ONLY)-REQUEST PROCESSED IN 8 31N ItS DAYS <br /> SIG ATURE OF APPLICANT DATE O �_ <br /> UNIT DISTRIBUTION O Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 0 Unit 5 O Unit 6 ❑ Other(electronlclllstslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. Q <br /> FEE <br /> 2. I <br /> 3. Cl so <br /> 4. ic L M <br /> 6. y <br /> s. . <br /> 7. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROiJND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SI'rl_(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> 14DERCROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TRF.ATMgNT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑PUMPERTRUCKIYAFtDICHEM TOILETS <br /> ❑TAT7001BODY PIPkCING Q POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FWt REYIEW- MONDAY-FRIDAY 3:00 AM-6:00PM - 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 file type MUST be selected. Fax to(209)464-0138 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 /> n <br /> EHD A"2-M <br /> 1H4105 <br />