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Jur. 19. 2006 10:46AM A-' ced GeoFrvi ronmertal No, 52J 1- P. 2 <br /> DATE ktc;tivtU �Hi7�.vv IJUPo1BER <br /> SAN JOAQUIN COLTIT'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor, Stockton, CA 95202-270$ <br /> Telephone: (209)468-3420 Fag: (209)464-0138 Web:vnvw.sigov.org/ehd <br /> r, <br /> PUBLIC RECORDS RELEASE APPLICATION i <br /> APPLICANT:S U Y1 _ e0 BUSINESS/AGENCY: V12 <br /> ADDRESS: J Q Q S� L /�r, �� p r / (' <br /> PHONE(1): Q PHONE(2): '! 2S FACSIMILE: /Qj7 ' V/0 <br /> TENTATIVE*APPOINTMENT DATE: l:�- 411 Time: <br /> (Please allow 10 b slnass days from date of application submittal-`Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDIT R T.$93.00 FEE( SH OR ECK ONLY)-REQUEST FROCESSED IN 3 BUSINESS GAYS' <br /> SIGNATURE OF APPLICANT Z DATE <br /> UNIT DISTRIBUTION 0 U it 1 d=,It ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(eloctronic/1 4Wma.ps) <br /> FILE ADDRESS EHD USE ONLY <br /> Straetl� -Street Name City <br /> 2. <br /> 3. <br /> d. Ec . WOW <br /> 6. <br /> 7. I <br /> S. P AF <br /> A. <br /> Speci is Date Randa of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUNCI TuIK(UST)CLEANU SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIR MOVAL) ❑DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH G WASTEWATER TREATMENT PLA r <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ,,0 PusIPER 7xuCK1YARRIG{EM TOILET^a <br /> ❑TATTo0180DY PIERaNG ❑POOLISPA ND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT)RECORDS ARE AVAILABLE FOR REVIM - MONDAY-FRIDAY 11:00 Ala-5:00PM - EXCLUDING HOU11AYS. <br /> 1. List up to tett addresses Ir 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. Addresi ranges will not be accepted-for additional assistance with file addresses, contact <br /> the EHD.Applications reci ilved after 3:00 pm will be processed the next business day. <br /> 2. The EHD vAll notify the ap licant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)da after receipt of application, The files will be held for a maximum of flye bush <br /> days for review. Appoin eats should be scheduled accordingly. <br /> 3. A file that is actively bein worked on by EHD staff may not be immediately avallable for review. A new <br /> Application may be submi ed 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 expensci of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> r. <br /> l�r <br /> EHD4UZ-405 v <br /> lM4= <br />