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Dec. 29. 2006 11 : 16AM Ad ced GeoEnvi ronmental 41 No. 7174 P. 1 <br /> DATE RECEIVED CHD LOMBR / <br /> SAN JOAQUIN COUNTY <br /> Fo a ENV�tONMENTAL HEALTH DEPARTMENT' <br /> L�DD 304 East'Weber Avenue,3'd Floor,Stockton,CA 95202-2708 <br /> 'telephone: (209)468.3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd Aft C' <br /> DEL 2 9 22005 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AMOMYI`SG� BUSINESS/AGENCY: ®�yalnttd ut 1 <br /> ADDRESS: + g� 'Ro024 <br /> 1 <br /> PHONE(1): �'i Q9 !' 100(6r .PHONE(2): Q 2 ACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE Time: <br /> (Plea5e allow 10 busin eye from date of appllcatlon submittal-•'r entatrve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE QUEST-$85:00 FEE(C H R CH K ONLY)-REQUEST PROCESSED IN 3 B SINESSS 5 <br /> SIGNATURE OF APPLICANT DATE /A aq Q40 <br /> Electronic information: ❑ Ust❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ unit 1 <br /> t,)rF I. aLt DO Eo -ST l 0-3mrSTa <br /> V sfl z. a43 tJnit2 <br /> Nff 3. <br /> &D <br /> N�5 6. apt�a EaSr -r r rangy <br /> �unit44. <br /> ,. <br /> tQ V- s. 0r^ -.3 2007 <br /> T- ❑ Unit 6 <br /> 8. <br /> 9. f�rYUnit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to M <br /> ENVIRONMENTAL HEALTH DEPART T FILES 2Q/7 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ®HOUSING ABATEMENT SOLID WA5TE.FACILITYNEHICLE <br /> 1 OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONiTORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 13 WAsTEwATERTREATMENT PLANT <br /> TIERED PERMITTED FACILITY l3 MOTELIHOTEL CI PUMPER TRUCKIYAROICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING Q POOLISPA ALAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY p OTHER(PLEASE SPECIFY) <br /> WELL AND SEPnO PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDING HouoAYs. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition ae'released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> PHO"9/73/2 <br />