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May , 31 , 2001 8 : 13AM ArIvanced Geo Environmental No . 8774 8 . 1 <br /> � EHD LOG NUMBER <br /> t� SAN JOAQUIN COUNTY <br /> Ifll ENVIRONMENTAL HEALTH DEPARTMENT <br /> MM 3 1 2007 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 r ,� <br /> Telephone; (209) 4683420 Fax: (209) 464-0138 Web: www.sjgov.org/e O <br /> ENPE ONM - 4 EtHCES N PUBLIC RECORDS RELEASE APPLICATION pF <br /> APPLICANT: -(� (�. b � lCtt-� BUSINESS/AGENCY; (xt'd .Rvl'NVL.y.u..a,�,� r (aw <br /> ADDRESS: ' � �J � 5Ir%VU P13 kbEMS <br /> PHONE (1); PHONE (2): Dl � " r"{Oa �rJS�J iJ FACSIMILE' Y� I <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 RE T • S 0 FEE 3H OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESSDAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION d Unit 0 Unit Unita 11 Unit 111 Unit © Unit ❑ Other (electronlcnisfslmaps) <br /> FILE ADDRESS END USE ONLY <br /> Street It Street Name City <br /> LLL <br /> 2. a ` o$(7 �1srr rn r <br /> — <br /> 3. 60 D rvkaY so. --- cwt r <br /> 4. y <br /> 9. <br /> 10. - - <br /> Specific Date Range of Information Requested: From - t Q�o to D1-PS�+•�. - <br /> y, ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> yl. UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUBING ABATEMENT LT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE (NON-LOP) M FOOD FACILITY El WASTE TIRE <br /> UNDERGROUND TANKMONITUN <br /> ( NGIREMOVAL) 0 tlOG KENNEL 11 DAIRY <br /> gLHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> 11 TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITE$ <br /> 0 MEDICAL WASTE FACILITY M OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY•FRIDAY 0:00 AM•G:OOPM EXCLUDING HOLIDAYS, <br /> I . 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 (2091464-0136 or mall to the address <br /> indicated above. Address ranges will not be accepted — for additional assistance with file addresses, contact <br /> the EHU. 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 be confirmed <br /> approximately ten (10) days after receipt of application, The files will 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 available. <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 /> EHD 40,02.096 <br /> v�a9e <br /> 3133 <br />