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06/27/2006 10:53 FAX ID002 <br /> DATE RECEIVED EHD lQG i�UN1I3cR <br /> SAN JOAQUIN COUNTY <br /> ENVIR®taTM1i NTAL HEALTH DEPARTmNT <br /> 304 East Wcber Avenue,3r°Floor, Stock.-ton,CA 95207-2708 <br /> Telephone:(209)468 3420 Fare:(209)464-0138 Web:N&vw.sjgoy.org/ehd <br /> PUBLIC ' +CORDS RELEASE APPLICATION _ <br /> APPLICANT:� l� �,. f S.USSIINESS(AQENCY: && r <br /> ADDRESS: &I�t7 ki• jig MRI r LN t1 P!P" <br /> PHONE PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: rim: <br /> (Pima allows 10 businon days from date of appruation submittal-`Tentatr"ant -newt be con d) <br /> ® CHECK BOX TO EXPEDITER U -$93.00 F ( HECK ONLY-REQUEST PROCESSED IN 3 BUSINEW DAYS <br /> SIGNATURE OF APPLICANT DATE h w TO <br /> UNIT DISTRIBM ION d Unit Unit ❑Unit 3 ❑Unit A ❑Un3E S ❑ Unit 6 ❑ Othar(clecimnicift maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street a i- Stmt Name Gity <br /> 2. <br /> L74Sim I �, <br /> Speck Dale Range of Information Requested.From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATBWXT ❑SOLID WAM FACIUTYMEHICLE <br /> OTHER CLF-ANUP$ITE(NON-!,OP) ❑FOOD FACtU Y O WASTE TIKE <br /> UNDERGROUND TANK(iSOMTOMNGIRFM AL) Q Doe Kowei. ❑DAiRY <br /> HAZARDOUS WAMM GENERATOR ❑CHICKEN RANCH ❑WASTONATER TREATMENT PLANT <br /> ❑MERE7D FERWrrED FACi M E3 MOTMAJOTEL ❑PUm'{.R TRUCVJYARWCHRM TOILETS <br /> iD TArooIBow Pimm 0 POMAPA ❑LAND USE APPLICATION SITES <br /> ID MEDICAL WASTE FACILITY ❑OTNER(PLEASESpEct� <br /> WELL AND SEPTIC IPEWn'RECORDS AFIE AVAILABLE FOR REVIEW- MOMAY-FRIDAY 8:00 AM-S:t 0pm - E)(GLuu!NG HoubAYS. <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 /> 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 he confirmed <br /> approximately ten(10)days after receipt of application. The files wl'li 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 staff may not be immediately available for review. A new <br /> application may be submitted when the file is avallable. <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 /> ,ti r <br /> EW"47-008 ••••• v <br /> 1(14.ro6 <br />