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03/21/2007 14:01 2133800 ENVIRONMENTAL PAGE 01/01 <br /> BTE EJVED- EHD LOG NUMBER <br /> 11 �,,';1L, G; SAN JOAQU ; COUN'T'Y <br /> H)LizENVIRONMENTAL HEALTH DEPARTMENT <br /> cin 0 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> A p "p Z0`7 f L Telephone:(209)468-3420 Fax:(209)464-0138 Web: WWW.sjgov.Org/ehd <br /> �IJVIRUP'afv�r'.fvl i'Ci-�1L�11 <br /> PFR(jITlc lnl;; �, PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; V-1C'0 I..G,L�S/�� SU$INESSIAGENCY: E/yC01--N <br /> ADDRESS: rfd�. �Jj�. 5'V17-� (SOS Z.,�- Ca 9Ub/p _ <br /> PHONE(1): Ztr ��5?2— bSSS PHONE(2): 393 — FACSIMILE: Z/Ste-3cS�a — CaSOS <br /> TENTATIVE*APPOINTMENT DATE: rima: <br /> (Please allow 10 business days to of n submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU T-$95.00 F (GASH O ECK ONLY)-REQUEST PROCESSED 1N 3 USIN SS DAYS <br /> TE <br /> SIGNATURE OF APPLICANT DAZl C>;?--- <br /> Electronic Information: [:]List❑ Map- escrip don: <br /> FILE ADDRESS — EHD USE ONLY <br /> Street Name <br /> Sweet* StCity - ❑ Unit 1 <br /> _..... .__ .t_ n <br /> 2. 1 ❑ Unit 2 <br /> a. ; A <br /> 4 Unit 3 <br /> "P"'p'F <br /> 6. <br /> 7. <br /> -- - - ---- .... ❑ unit s 4 <br /> ..--------------- ❑ units <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> EIV V IRONMEN T AL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT Cl SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY O WASTE TIRE <br /> -UNDERGROUND TANK(MONITORING/REMOVAL.) ❑DOG KENNEL Q DAIRY <br /> HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> Q TIERED PERWTTED FACILITY 0 MOTEL/HOTEI, EI PUMPER TRUCKJYARD/CNEM TOILen <br /> 13 TATTOO/BODY PIERCING 13 POOLI$PAG LAND USE APPLICATION SITES <br /> 11 MEDICAL WASTE FACILrfY 4LOTfiER(PLEASF SPECIFY) v <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MON13AY-FRIDAY 9:00 AM-9:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten 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 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 flies 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 /> Qi­o,PAD USE ONLY <br /> C cwt z -tom u� — <br /> Y (� 0 r c) <br /> EMD 16-0s 911312000 <br />