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12/18/2007 11: 21 213380E ENVIRONMENTAL PAGE 01/01 <br /> DATE RECEIVED [HD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONAIENI'AL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 V <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjg0v <br /> PUBLIC ECORDS RE-LEASE .A.PPLICATION <br /> APPLICANT: } BUSINESS/AGENCY: <br /> ADDRESS: /j Q i Z 9 C- C 11 E'ET'- <br /> R'j <br /> PHONE(1): S U O� YI-2 36-16 PHONE(2): <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST- 5-00 EE(C S/�OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � � vv DATE 4j � <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Na_me City 0 Unit 1 <br /> 1. �rJ v "I o - <br /> b�L z. a, coo 1� �. �� as I"1 - app U a(\ce, 010 knit a <br /> �1 3. <br /> ( A 4nit 3 <br /> n 01 5. v <br /> g Unit 4 <br /> 7. <br /> —,- -� - Unit 6 <br /> 8. <br /> 9. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLIID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE INON-LOP) E3 FOOD FACILITY �WASTETIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR✓ ❑CHICKEN RANCH �lWASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY,/ 4 MOTI!UHOTEL ©PUMPER TRUCKlYARD/CHEM TOILETS 1 <br /> t�TATTOO/BODY PIERCING 13 POOLfSPA LAND USE APPLICATION SITES 1 <br /> d MEDICAL WASTE FACILITY E3 OTHER(PLEASE SPECIFY) <br /> WELL AND SrPnC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS, <br /> 1. List up to ten addresses In the space above. Select the typo(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 address indicated 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 /> EHD USE ONLY <br /> EHD A8.06 9113h008 <br />