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MHN-1b-2007 08:26 TER CON — ROSEVILLE 916 784 3487 P.01i01 <br /> ® , EHa LOG NUMBER <br /> DATE RECEIVED ` �(' SAN JOAQUIN COUNTY <br /> RECE11WED ENVIRONMEN" AL HEALTH DiEPARTIVXENTAM .N& <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> Mk, 1 6 2007 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/eh <br /> ENVIRONvIInL-iI NEATIH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT• BUSINESS/AGENCY: <br /> ADDRESS: - - eJ� �/��j — <br /> +� FACSIMILE:9110' I z e <br /> PHONr�E(2)=_ , <br /> TENTATIVE APPOINTMENT DATE:,J 1�/01 Time: L13 0 <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITER QUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT .. 11 DATE S I lP I D1 <br /> Electronic Information: ❑List Q Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 8troet street Hama __� City ❑ unit 1 <br /> ❑ unit z <br /> 2. <br /> 1—i.— <br /> ' Awl Urit3 <br /> 6. - - IOff Unit 4 <br /> S. ' <br /> r77. unit s <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TMK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ,,r TSOt.ID wASTE FAoLrryNEtucLE <br /> O OTHER CLEANUP SITE(NON-LOP) ®FOOD FACIUTY ®WASTE TIRE <br /> ,,JWUNOERGROUND TANK(MONITORINGIREMOVAL) ®DOG KENNEL ®DAIRY <br /> RDOUS WASTE GENERATOR a CHICKEN RANCH ®WASTEWATER TREATMENT PLANT <br /> O Tlemo PERmTTED FACILITY 17 MOTEUHOTEL 13 PUMPER TRUCK/YARD/CNEM TOIL: S <br /> Cl TATTOWDOOY PIERGNG 0 P=JSPA 17 LAND USE APPLICATION SM <br /> ®MEIAGAL WASTE FAMUTY 13 OTHER(PLEASE SPECIFY) <br /> WEU AND SEPTIC PeRmr RECORDS ARE AVALLAmE POR REv.iEw- MONOAY-FRIDAY 8:00 AM-5:00PM - ExcLUO1NG HOUDAYS. <br /> 1. list up to ten addresses in the space above. Select the type(*)of files from the Not above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209) %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 prn will be processed the next business day. <br /> 2. The EHO 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> END 49M gnI-zma <br /> TOTAL P.01 <br />