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May. 18. 2006 9. 52PM Advanced GeoEnvironmental No. 4936 '. 2 <br /> (DATE RECEIVED EHD LOG N111-48ER <br /> u u <br /> EC l�LI <br /> YE� SAN JOAQ'UIN COUNTY � <br /> ENVIRONMENTAL][-HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> MAY' u CO�b Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENMIRM01ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: U zan 6 n ,, r/ BUSINESS/AGE(N'�CY:. <br /> ADDRE-38: r/ 6 Q STO C — �} '1 J <br /> PHONE(1):��/ - 7 l -100& PHONr-(7): ol10�`.T - !1c?! ` �a���S FACSIMILE: b <br /> TENTATIVE*APPOINTMENT DATE: � hUq i&l)i� Tlme: 1j)-OD AO-, . <br /> (Flease allow 10 business days from date of app, .ration eubmlttal-"TentaVye only-must be conilrmod) <br /> CHECK BOX TO EXPEDITE:j��UET-$93.00 FEE(CA CH K ONLY)-REQUEST PROCE§SED IN 3�BU/S]I/NJ��SlS DAYS <br /> SIGNATURE OF APPLICANT - DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 dUnIt2 OU nit 3 ❑ Unit 4 ❑ Unit S L Unit 5 Q Other(electronlc/Ilsts/maps)_ <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City <br /> 1. U / C <br /> 3. ET1 0 0 !t tr <br /> 4. U Of <br /> 5. C uj 7 Pa C' ars , <br /> 6. ` <br /> SCh I <br /> 60 <br /> 8: rn t3EI <br /> s. <br /> Specific Date Range of.lnformation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE'S <br /> sUND£ReROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT C1 SOLID WA&TE FACILITYA EHICLE <br /> THEIR CLEANUP SITE(NON-LOP) 11 FOOD FACILITY ❑WASTE TIRE <br /> !UNDERGROUND TANK(NIONITORINGIREPROVAL) 173 Doo KENNEL ❑ DAIRY <br /> H.AZ.ARDOU$Y'IAZTE GENERATOR 11CHICKEN RANCH ❑WASTE'W'ATER 7RE..ATMENT PLATT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> C TATTOO/BODY PIrRGNG d POOIISPA GLAND USE APPLICATION SITES <br /> G MEDICAL WAETE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:O0PN1 - EXCLUDiNO HOLIDAY$. <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 alddres <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addresses, c4-itact. <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 flies exist. An appointment for revlew will be confirmed <br /> approximately ten(10) daya after receipt of application. The files will be held for a maximum of fiva busiriw* <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that if;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 available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expanse of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prier to review. <br /> EHD 4342.008 <br /> 7!14105 <br />