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UAAar. 2. 2006 11 : 03AM Advanced GeoEnvi ronmental No. 4101 2., <br /> -5AIN JOAQUI.N UOUIN't'Y <br /> OVIRONMENTAL HEALTH DEPART_MENT <br /> 304 East Weber Aveiaue,3rd Floor, Stockton, CA.95202-2708 <br /> Telephone: (209)468-3420 Fax- (209)464-0138 Web: Nvww.sjgov.orgfehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l w �i - ���- BUSINESS/AGENCY: <br /> ADDRESS: 7 <br /> PHONE(1): 1�� PHONE(2): 7 v�'S �• FACSIMILE: L <br /> TENTATIVE"APPOINTMENT DATE: z- d Time: <br /> (Please allow 10 business days from date of applic tion bmittal•'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE{CA H OR CHECK ONLY) REQUEST PROCESSED IN 3 BU iNE AYS <br /> SIGNATURE OF APPLICANT � pgTE <br /> UNIT DISTRIBUTION ❑ Unit 1 Q Unit 2 O Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street it Street Name Ity <br /> 2. <br /> 3. <br /> 4. <br /> s. ; <br /> 6. <br /> 7. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From APv,I2 Q:) 1 ` to <br /> ENVIRONMENTAL H ALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 13 SOLID WASTE FACILITYIVEHICLE <br /> ❑ETHER CLEANUP SITE(NON-LOP) ❑FgoD FACILITY ❑WASTE TIRE <br /> ,-ZTUNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS- <br /> 1. <br /> OLIDAYS_1. List up to ten addresses in the space above. Select the type(s)of files from fb---- above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Lax_tr­"—__ or mail..to the address <br /> indicated above. Address ranges will not be accepted 7— ith file addresses, contact <br /> the EHD.Applications received after 3:00 pm will h' Pages <br /> b <br /> 2. The EHD will notify the applicant if an­,­-- Date 3 D ° I be confirmed <br /> approximately ten (10)days-"' -76TFrom I . D t)mum of five business <br /> days for review. Ap-- F Note D ?G <br /> 3. A file that is actively post�t® �71 (� jii 1 PhD�e a (� review. Anew <br /> application may be sG -v <br /> 4. Any file not returned h co•IDept A�7 FaX# , cHD staff at the expense of the <br /> applicant. Future file rt Prone# I(l� Ya6.00 deposit prior to review. <br /> END 40-02-006 <br /> 1114106 <br />