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06/27/2006 10:58 FAX 0002 <br /> DATE RECEIVED EHD LOG fJUPABER <br /> SAN JOAQUIN COUN'CY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Wcber Avenue,3r°Floor,Stockton,CA 95207-2708 <br /> Telephone:(209)46$3420 Fax:(209)464-0138 Web:wvrw.sjgov.org/ehd Z .3750"" <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: UPAt, BUSINESSIA0ENCY: <br /> ADDRESS: 6&B 12 <br /> PHONE 411: M!j jz'" PHONE(2): FACS1WLE: �3L <br /> TENTATIVE*APPOINTMENT DATE: rime: <br /> (Piease allow 10 business days from date of application submittal-`TEntsOve only-Must be ctn fi mad) <br /> CHECK.BOX TO EXPEDITE R U -$93.00 F ( HECK ONLY)-REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT DATE1. 'Is` <br /> UNIT DISTRIBU ION Ct unit Unit ®Unit 3 ❑Unit 4 13 Unk S ® Unit 6 17 Other(clearonic/11SWmaps) <br /> FILE,ADDRESS _. EHD USE ONLY <br /> 2. <br /> 4. <br /> I'L.i 1D_ <br /> �. <br /> �o. [I-TE <br /> a.wa �► <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILET; <br /> U O TANK(UST)CREMUP SITE(LOP) ❑Housm AsATEmENT ®Souo WASTE FAau-ryIveKcLE <br /> OTHER CLEANUP SITE(NON4,OP) Q FOOD FACLI Y E3 WASTE TIRE <br /> UNDE:RWOUND TANK(MONLTvRIN AL) 0 Dos KENNEL ®DAIRY <br /> HAZARDOUS WABTE GENERATOR Q GHICKEN RANCH ❑WASTEWATER TREE ATMENT PLANT <br /> TIERED/PERMnTED FACILITY 0 MO 11JHOTEL ❑PUMPI.R TRUCKIYARWHEM TOILETS <br /> G TATToon3wy PIERCING Cl POMMIFA ❑LAND USE APPLICATION SITES <br /> 13(MEDICAL WASTE FAGN]TY 13 O MM(PiEAASESPEctFyl <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- M0mbAY-FRIDAY ll:00A i.&00Fm - EXCLUDING HOLIbAYS. <br /> I. 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 L2091 46"138 or mall to the address <br /> indicated above. Address ranges Y411 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 /> L <br /> END 4842-008 , <br /> 9M4.ro6 <br />