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06/27/2'006 10:53 FAX 1! 002 DATE RECEIVED EHD LOG t�UPA6=R SAN JOAQUIN CO-UNTY ENVTRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3rd Floor, Stockton,CA 55202-2701 Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sjgov.or;/ehd _ PUBLIC RECORDS RELEASE APPLICATION APPLICANT:_,I�� BUSINFSSIAGENCY: l/�J 1 — YGwt1--==i= •C� ADDRESS:_ ��Q Mp'.I+lact,. Lm. — PHONF(1):jjjL M-4—jmj"—PHONE(2): FACSIMILE:11291 Ir?p TENTATIVE*AFPOINTMEtrr DATE: Time: (Please allow 10 business days from date of application submittal-'Tentative ontf-must be contimrad) ❑ CHECK BOX TO EXPEDITE R U -$93.00 FE (C R HECK ONLY)-REQUEST PROCESSED IN 3 BUSINES?DAYS SIGNATURE OF APPLICANT DATE b 41 _ UNrr DISTRCIA ION d Unit Unit ❑Unit 3 ❑ Unit4 ❑ Unit$ ❑ Unit 6 ❑ Othar(6loctmnle st'Irnap:t)Tp� !P FILE ADDRESS _ ... _ EHD USE ONLY Street it Stree`:M11ame city_ 2. ;52 0 1. A. 1191 _ RAItH7. M�i�_�t.N_------ tj9. m U01.1455:_. Specific D2f:e Range of Information Requested:From to _ ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(1.017) ❑HOUSING ABATEMENT ❑SOW WAS FAULITYN EFICLE OTHER CLEANUP SITE(Novi-LOP) Q FOOD FACILITY ❑WASTE TIRE UIVDERGROUND TANK(1A0NR0RIN41REM0YAL) ❑DOG KENNEL ❑DAIRY HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TRaAwENT PLANT ❑TIERI•D PERMITTED FACILITY 0 MOn MHOTEL ❑PuMPCR TwcK/YARDICHwA ToILETS TATTOOIBODY PIERCING Q POOL/SFA ❑LAND USE AFPLICATION RTES CJ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) `VEL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- 1110mb1Y-FRIDAY 8:00 AMv:00vm - EXCLUDING HOLIDAYS._ 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)04-4138 or mail to the address indicated above. Address ranges will not be accepted–for additional assistance with file addresses,contact the EHE),Applications received after 3:00 pm will be processed the next busine-ss day. 2. The EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately ten(10)days after receipt of application. The files will be held for a maximurioffive business dad{s for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application, may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the lipplicant Future file reviews by the same applicant may require a$93.00 depo:tit prior to review. t ' E140 4",7-006 1114,06