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� 4�/1B/2006 10:59 FAX r 1�002/002 <br /> DATE RECE non <br /> (D SAN JUAQUTN COUNTY ' EHD LOCA NUM6ER <br /> NVm0NMENTAL HFALTH DFPA1:tTm ENT <br /> JAN I (� East Weber Avenue, 3r"Floor Stockton, CA 95202-2708 <br /> - nmep one:(209)468-3420 Fax: (209)464-0138 Web.,www.slgov_orglehd <br /> ENVIRONMENT HEALTH <br /> P�BMIT/SERVKXUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t) BUSIf'iESSIAGENCY: <br /> ADDRESS: - Gfi7__SMZ ',^...STATE. <br /> PHONE(I PHONE(2): ACSIMILE:�A <br /> TENTATIVE"APPOINTMENT DATE: Time: I Z_ _ <br /> (PI9n0 allow 10 bvsineas days from daft of appCtadon aubmilfal-7aer~trvel <br /> only-must be confirmed) ] <br /> CHECK BOX TO EXPEOM REQU T-:93.04 FEE. H OR CHECK ONLY)-FMQUEST PROCESSED IN:BUSiNESS DAYS <br /> SIGNATURE OF APPLICANT VAJ DATE Q <br /> Erectrunic p Llst D Map-Descrip <br /> Informadon fJan <br /> FILE ADDRESS <br /> strEHD USE ONLY <br /> e+rt s street Name city I <br /> 1. <br /> 2. �') ❑ Unit .7 <br /> . c S <br /> Un <br /> 4. 1 it 2 <br /> n <br /> 6. Unit 3 <br /> 6. { anti r <br /> p <br /> Unit 6 <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requewted;Prom to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> V UNDERGROUND TANK(U371 CLEAr4up SITE(LOP) iO HOusINd A9A7E%iRx? -1 SOLD WASTE FAciLnWVekicLE <br /> t&,�j�OTHM CLEANUP SrTE(NON-LOP) O FOOD FACxm 0 WASTE TIRE <br /> MUNOERGROUND TANK(MoK=mNWREmNAL) 0 DOG KENNELIRY <br /> 09 I LUMDOUS WASTE GENERATOR 0 CHICKEN RANCH �WDAIRY <br /> TR.MATMENT PLMr <br /> O TIERED PERVIi I FACmw ❑MOTELM(TEL n PUMPER TRUCNITAROICHEImrAL TOILETS <br /> E3 TArrOOIBODY PIERcmG D PaoLiSFA )q LAND Uss APFucAum Snu <br /> MEDICAL WASTE FACILITY O OTHER(PDAs[:sPEcIFY) <br /> WELL AND SEPTIC PERIL a RECORDS ARE AYAIL.Aa"FOR Raw-MONDAY-FRIDAY 9:00 Ah":OOPi1 - MMUCINc HOLIDAYS........,_ <br /> 1. List up to ten addresses In 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 /> tndicated above. Address ranges drill 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. " i <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 recelpt of application. The files will be held for a mWrnuln of five business <br /> days for review. Appointments 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 <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 i <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> @ID 4601 .1 <br /> lOA1f200r <br />