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Jun. 19. 2006 10:46AM Aced GeoEnvi ronmental No. 52;1_ �. 2 <br /> DATE kti;tlVtU SAN JOAQUIN COCOUNTYcH0�.v�idUMBER <br /> HEALTH DEPARTMENT ;304tNVIRONMENTAL <br /> est Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/chd <br /> PU LIC RECORDS RELEASE APPLICATION � <br /> APPLICANT: U Y1 QI f BUSINESS/AGENCY: <br /> ADDRESS.•_ Jry o a S`zo !!L p r �y p/I (� <br /> PHONE(1),„ 1 ~ (, Q PHONE(2); 1 ,W Z V FACSIMILE:26 !' 7 1 /`! / is <br /> / _ ! <br /> TENTATIVE"APPOINTMENT DATE: � � Time: ' G��r <br /> v <br /> (Please allow 10 b slnm days from date of application submittal-`T"entaUve onty-must be zonfirmed) <br /> CHECK BOX TO EXPEDITER T-$93.00 FEE( SH OR ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAY- <br /> SIGNATURE OF APPLICANT Z DATE <br /> UNIT DISTRIBUTION CI Urd 1 D Unit 2 ❑ Unit 3 13 Unit 4 C3 nit 5 ❑ Unit 6 ❑ Other(electronlc/lI>:Wma.ps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street t1 Street flame city <br /> 2. <br /> 0-6a 1v -aug- <br /> 4. O O CH, Eu M I Ixiiiiiiii1m WOW <br /> AA 61M <br /> Now <br /> 7. <br /> All <br /> S- <br /> 9. <br /> Specific Date Rangy of Information RegUested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND T{,NK(UST)CLEANUP ITE(LOF) ❑ HOUSING A13ATEMENT ❑SOLID WASTE FACILITY <br /> OTHER CLEANUP a1'FE(NON-LOP) d FOOD FACILITY ©WASTE TIRE <br /> UNDERGROUNti TANK(MOMTORINGIREMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> HA2ARDOVS WAST E GENERATOR 0 CHICKEN RANCH G WASTEWATER TREATMENT PLA <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUFIPER TR=YARDICHEM TOILETS <br /> ❑TATCOoIBODY PIERCING ❑POOUSPA LRND UbE APPLICATION SITES <br /> M MECICAL.WAS"E FACILITY ❑OTHER(PLEASE SPECIFY) (' <br /> WELL AND SEPTIC PERMIT CORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 6:00 Aa1-6:0017w - EXCLUDING HOLJEIAYS. <br /> 1. List up to ten addresses In 1he space above. Select the type(s)of files from the list abode 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 /> Indlcated above, Address rangea 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 vAll 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 businass <br /> days for review. AppoIntme nts should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately avallable 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 review-by the same applicant may require a$93.00 deposit prior to review. <br /> EHD4"2.006 �~ <br /> tn4= <br />