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A tib) <br /> SAN JOAQUIN COUNITY <br /> ENVIRONMENTAL!HEALTH DEP.ARnIENT jq313 <br /> AUG1 2005 104 East Weber Avenue, 3,"Floor, Stockton, 2-2708 <br /> Telephone: Aw <br /> (209)468 3420 Fax: (209)464 01 8 Web: ww.Os gov.o&hd <br /> ENVIRONMENT HEALTH <br /> PERVT/5ERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: bf4 I Q"'` A%4� I BUSINESSIAGENCY: ALleE <br /> ADDRESS: Z� tIw r)r. Tyr\>,t1C ICP c(Y'S'61 <br /> PHONE(t): Z.�7 Ce�'�- PHONE(2): 267 �'G4�`Cl6Y�"FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: 13 Z!'' `�� Time: 09� <br /> (Please allow 10 business days from date of apiplication submlttal•'Tentative only.must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 E USINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT IAK B <br /> UNIT DISTRIBUTION OUnit 1 OUnK2 OUnit Unit ❑ Unit6 O Unit6 O 0ther(electronicAiststmami, <br /> FILE ADDRESS EHD USE ONLY <br /> street9 street Name City <br /> 1. 7S t cwt 5 I S Ut �. <br /> 2. i{O S t N.v.>• iti LK a. <br /> 3. 5302 tt� Lc� C tk <br /> 4. j7_ie5 F, FY•eJ.No✓�' S-I•. .$ <br /> 6. 15 3 S. �¢ lnc t fid• ESL+1o� 502 <br /> 6. <br /> 7. to 1 S rtit >✓ <br /> g, (O°0 o ro lea i tK )'h <br /> h"- <br /> 10. ZJ 32- E. Marc q 5 L <br /> Specific Date Range of Information Requested:From I to <br /> +�,,r� EAO ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> y UNDERGROUND TANK(USTI CLEANUP SITE HOUSING ABATEMENT ❑SOLID WASTE FAgLrYIVET9CLE <br /> ❑OTHER CLEANUP SITE(NON•LOP) ❑ FDOO FACILITY 13 WASTE TIRE <br /> El UNDERGROUND TANK(MONITORINGtREMOVAL) O DOG KENNEL O DAIRY <br /> 04jVV WoMWASlSAZeNM 1TOR �CNOIeIlItilMlpl d�W6TLWnlIRARYI?III�rA1Mf <br /> 0 TIERED PERMITTED FACILITY O MOTELIHOTEL [3 PUNPERTRUCKIYARo1CHEM TOILETS <br /> O POOL/SPA IM LAW USE APPUCATION SITES <br /> E3 TATTOOIBODY PIERCING MEDICAL WASTE FACILITY l7 OnER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMITRECORDS AREAVAII MB FOR RENEW • MONDAY-FRIDAY 8:00 AMd:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of tiles 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. Address ranges 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 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 stalmay 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 /> EHD411-024N <br /> 111"s <br /> I <br />