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01/:0/2006 09:49 FAX 1 209 11, *1STOCKTON 1&002 <br /> 01/10/20u76 09:34 4640136 ENVIRONMENTAL HPA 01 <br /> E�� <br /> cnu Lua I unmcrt <br /> UAI t KtUtIVCU SAN JOAQUIN COUNTY <br /> CUt jr'I\ ENVIRONMEN'T'AL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3'�Floor, Stockton, CA 95202-2708 <br /> {QC; '• ® <br /> 204elephoffi: (209)468-3420 Fax: (209)464-013S Web:www.sjgov.org/ebd <br /> ENViRUf�''tt )l �'ASI USLIC RECORDS RELEASE APPLICATION <br /> APPLIC ' ILk 1 - 5 1 9USINESSlAGENCY: <br /> ADDRESS: �G I' tV 1-to.wvn,. ltw - 'Su.i f't.F CITY z.VV" STATE_ <br /> PHONE(1$ 231(-77 Zt PNONE l2): FACSIMILE: `L3N -7727 <br /> TENTATIVE"APPOINTMENT DATE: rime: <br /> (Phaco allow 10 business days from date of appficatim=bmrdal-"regaffm only-must be c <br /> ( CHECK BOX TO EXPEDITE REQ ' 0`00 H OR CHECK ONLY)-REQUEST PROCESSED I <br /> SIGNATURE OF APPLICANT f, �L/ 1 � DATE I e ' <br /> Electronic O Vat O Map-Desodpae <br /> Infortnatbn <br /> FILE ADDRESS END USE ONLY <br /> street# Street Name City <br /> 1. ❑ 4Jnit 1 <br /> 2. oo e- +i R<t ❑ Unit 2 <br /> 4, / Unit 3 <br /> 6. J2f Unit 4 <br /> 7' Unit 5 <br /> 6. <br /> 9 Unit 6 <br /> specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH PARTMENT FILES <br /> Ip HOUSINGA6ATEMMT SCUD WASTE FAMRYNEHICLE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) FI. awAST6 Tie <br /> IK OTHER CLEANUP SITE(NON-LOP) ❑F000 FACILITY <br /> 15L UNDERGROUND TANK(MOHIroFMWREMOVAt.) E2 DOG KENNEL 13 DA ST <br /> 0'L HAZARDOUS WASTE GENERATOR ❑CHK:KEN RANCH 0 pUMpr.rATERTREAUICKEALAL <br /> SITIERED PERMaM FACILITY 0MOTELMOTEL 0 PUMP ERTRUCKICANNCNEAES TOILETS <br /> IL TATTOO(BODY PERCMO ❑POOUSPA ❑ L.AND USE APPLICATION SITES <br /> OemCALWASTHPACIUTY ElOTNER(PLEASESPECIFY) AIN � 1 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR FC"RW •MONDAY-FRIDAY 0:00 d:00pM - EXC WDINQ HOLKIAYB. <br /> 1.. List up to ten addresses In the space above. Select the types)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 209 64-0130 or ail to the address <br /> indicated abcvq Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD. Applications received after 3:uo 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(SO)days after receipt of application. The files will be held for a maximum of five b sines <br /> days for review. Appointments should be scheduled accordingty. <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. aAny file hot returned pplicant Future file lreviews by the same applicant mathe same condition as released yl be requirea$93.00 deposit anized HOprior staff <br /> too rev expense of the <br /> lew <br /> CHO "4< <br /> 10/bInNG <br />