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01/-0/2006 09:49 FAX 1 209 234 STOCKTON 002 <br /> 01/10/2006 09:34 4640138 ENVIRONMENTAL HE# P�gGE 01 <br /> UAIt KCL:CIVtU cnu Lw Numocn <br /> SAN JOAQUIN COUNTY <br /> Ci lc!'l ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 EW Weber Avenue, 3'1 Floor, Stockton,CA 95202-2708 <br /> l ! ' 2e31 clephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ebd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> T .., <br /> APPUC Ick \\1•- S 9USINESS 0eMCY: <br /> ADDRESS: W. 1 L�nL. k;+`F CITY 54-b'_k1r rt STATE <br /> PHONE(1): 1-3q-7-7Z2_ PHONE(2): FACSIMILE: 134 -7 7 7*7 <br /> TENTATIVE"APPOINTMENT DATE: Tune: <br /> (Please allow 10 business days from date of mWeatlon submittal-"rwrie&ve only-must be co <br /> ( CHECK BOX TO EXPEDITE REQU 93.00 C.AQH OR CHECK ONLY)-REQUEST PROCFSSEO I <br /> SIGNATURE OF APPLICANT — DATE I ro ti <br /> Electronic d p-Descd Uet ❑ Ma tion <br /> Informatbn P <br /> FILE ADDRESS EHD USE ONLY <br /> Street Strut Name City <br /> 1• 1 �. 9 It A �S <br /> 2- 00 E 4i, PJ 4Y <br /> 3. ❑ `U (t 2 <br /> S.S. / Unit 3 <br /> 6 JeUnit 4 <br /> 7. "-,ft <br /> 8. XUnit 5 <br /> 9. <br /> 10. xs Unit 6 <br /> Specific Date Range of Information Requested:From g� to <br /> DE <br /> ENVIRONMENTAL HEALTH PARTMENT FILES <br /> Ip UNDERGROUND TANK(1ST)CLEANUP SITE(LOP) KHOUSING ANATEMONT RSOLID WASTE FAMITYNEHICLE <br /> 1%OTHER CLEANUP SITE(Now-LOP) E3 FOOD FACIIAT RLWASTE TRE <br /> ffi UNDERGROUNn TANK(MONRORMOlREMOVAL) 11 Coo KENNEL ❑ DAILY <br /> K HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> I1A TIERED PERMITLD FACILITY ❑MOTELIHOTEL 11 PUMPERTRUCKIYAPAtCHEMALTOILET3 <br /> ,K,(T'�ATTOOIBODY P"CMO 13POOL:SPA Qn ❑ LAND USE APPLICATION$nEs <br /> V�mEDMALWASTE FACILITY 171 OTHER(PLIASE SPECIFY) A 1 <br /> WELL AND SEPTIC PEWrr RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 5:00PM - EXCLUONG 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 H 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 b iness <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 now <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 III expense of the <br /> appllcanL Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> Y.'� e <br /> END X846 <br /> fOntOW6 <br />