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03/21/2007 14:01 21338 5 ENVIRONMENTAL PAGE 01/01 <br /> P .ATE-REGEIVED BER <br /> SAN JOA.QUIN COUNTY <br /> ]ENVIRONMENTAL MALTH DF PARTMNZ' <br /> 304 East Weber Avenue, 3r4 Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ENV!R0N,1`i:J ;iCi1�i l <br /> t it PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ V-lC?O lNESS1AGENCY: /�CCJN <br /> ADDRESS: 3255 wr t Shlrf2 F= R-✓D ,, 5'v/rr= 1 SOS (2A <br /> PHONE(1): �c�- SSSS -PHONE(2): 393 62 6% FAcslnillLE_ i.3 3S10 - caSos <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days to of n submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU T.$95.00 F (CASH O ECK ONLY)-REQUEST PROCESSE7Z- <br /> U�/ C>S;DAYS <br /> S <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List Q Map- escrip Ion: <br /> FILE ADDRESS _— EHD USE ONLY <br /> street# _T' Street Name city ❑ Unft 1 <br /> �: �-OC� oSi;ivt 17 e t�� CA U cT I--t C'j <br /> 2. --— 0 unit 2 <br /> 3.. _..... _._ ... — ......... –.- A <br /> Unita <br /> 4. <br /> 6. <br /> -� y k <br /> 6. 1 .. <br /> PR 6 2007 <br /> 7. <br /> --- ....... _... —-----... _.. _._.._.. ._. ❑ unit s C <br /> unite &VO1111% <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> (ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1?i�ND£RGROUNO TANK(UST)CLEANUP 317E(LOP) E3 HOUSING AaATENI£NT ®SOLID WASTE FACIUTY/VEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILnY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ®DOG KENNEL CI DAIRY <br /> P,HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 17 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY E3MOTEUHOTEL 11 PumprR TRUCKIYARD/CHEM TOILETS <br /> C1 TATTOO/aODY PIERCING Q POOLI$PA A LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY AOTHER(PLEASE SPECIFY)— <br /> WELL <br /> PECIFY)WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REwEw. MONDAY•FRI13AY 8:00 AM.6!00pm • EXCLUDING HOLIDAYS. <br /> 1. List up to tan addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the addres lrldicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> 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 applicant. <br /> Future file reviews by the same applicant may require a$96.00 deposit prior to review. <br /> p HD USE ONLY <br /> EHD<BA8 9/13/2008 <br />