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06/15/2006 15:46 1 HORIZON PAGE e2 <br /> :1ATE RECEIVED SAN JOAQUIN COUNTY EHD toc ratl0+e•Er< <br /> [HE(��� � D ENVIRONMENTALHEALTH UEFAR2miNT <br /> V� fS 304 East Weber Avenue, 3'1 Floor. Stockton, CA 95202-2708 <br /> Telephoner(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/chd <br /> JUN � 006 <br /> E _ PUBLIC RECORDS RELEASE APPLICATION <br /> 4 BU SINESSIAGENCY: <br /> A 3. <br /> DDRESS:-(_QLN*TO <br /> �I i�nnd Ili. 1>>r. 5 O ortdo <br /> PHONE(tI:��6 L�71-i�'Zj Iy PHONE,�(2)�: �C 6I g FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: y, 1N l Iwo(O lime: <br /> (Please allow 10 business days from date f apollcation subm'dfal-'Tentative only-must be confirmed) <br /> C3 CHECK BOX TO EXPEDITE RE Is/y J$93.00 FEE CAS(`H OR CHECK ONLY)-REQUEST PROCESSED INS BURIN ESS DA`(S <br /> SIGNATURE OF APPLICANT / �(� t—' DATE rD r o 46 <br /> UNR OISTRIBU'gON ❑ Unit T O Unit 2 ❑ UnR 3 ❑ Unit4 ❑ Unn 5 O UnN E Other(¢IeutronlcOlstslm�hS1 <br /> FILE ADDRESS EHD USE 014LY <br /> Streets Street Name City2. — <br /> 1. <br /> 4. <br /> 5. <br /> 7, <br /> g, I <br /> 9. <br /> 10. —, <br /> Specific Date Range of Infomiaticn Requested: From )�`i S to --- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> }'�/UNDERGROUNO TANJ;(UST)CLEANUP Srm(LOP) ❑ HOUSING ABATEMENT ❑SCUD WASTE PACILIIYJVEHrLc <br /> L7-OTHER CLEANUP SITE(NDN-LOP) 0 P000 FACILITI' 13 WA.4TETI`t O <br /> ❑UNDERGROUND TANK(MONITORiI.WR-MOVAL) E3 Doc KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH t3 WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITI•ED FACILITY D MOTELIHOTEL 17 PUMPER TruaWYAROMHEM TOILETS <br /> til TATTOOIBODY PIEFICING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> O IIEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFII - <br /> WELL AMD SEPTIC PERMIT RECORDS APO AVAR.ABLE FOR REVIEW. MONpAYFRIDAY 8:00 Am-6:0OPM - EXCLUDINGGHOLIDAYS, <br /> _�- <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(20914 -0138 or mall to the address <br /> indicated abovee. Address ranges will not be accepted—for additional assistance with fife addresses, contact <br /> the EHD.Appllcations 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 w1IP 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 Ira slctively being worked on by EHD staff may not be immediately ay.allable far 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 I=HD staff at tive expanse o"the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> — <br /> J <br /> END 4"Z-WS <br /> tN4ms <br />