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Apr. 6, 2006 3:07PM Adv,nced GeoEnvironmental No- 4486 '. 1 <br /> DATE r«L.ci vcu -HD_.�.,,DUMBER <br /> SAN,�OAQUIN COUNTY ` <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3'd Floor, Stockton, CA 95202-2708ar�'1041 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/eh ?00002006 APR -6 Pik 4: 5 � <br /> YUBLIC RECORDS RELEASE APPLICATION <br /> 00JCA T;_' -;G, �i 60 Re) <br /> BUSINESS/AGENCY:E I'll <br /> V Yr UI YUU, <br /> A3 H Ii S <br /> C <br /> PHONE(1): V / ` 7 ! —100& PHONE(2): O//0/y` '71, o f7 2� FACSIMILE; 7 ' 7 1 '�l j <br /> TENTATIVE*APPOINTMENT DATE: i ��rQ2c}C <br /> (Please allow 10 business days from ate of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITER QUE -593.00 FEE( 0 ECK LY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unft 1 Unit 2 ❑ Unit 3 ❑ Unit 4 El Unit S 0 Unit a El Other(electronic/lists-'ma <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 1. CiS 7TIJ14nCh l kd C <br /> 2. <br /> 3. OS CtC Q <br /> 4. r a uJQ U� o rJ <br /> 5. S 7— A e^So tc3 <br /> c Win U� Rq <br /> � . <br /> 7. rr a <br /> S. �r�n <br /> 9. <br /> 10. � <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I.11iNDERGRCVND TANK(UST)CLEANUP SITE(LOP) M HOUs1NG ABATEMENT 173 SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNCERGROUNC TANK(MONII DRINWREMOVAL) 0 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH In WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM T01'_ET$ <br /> b TATTOO/BODY PIERCING POOL/SPA -- LAND US$4PPLICT ON SI� <br /> 171 MEDICAL WASTE FACILITYOTFiER(PLEASE SPECIFY)__t;} ltj <br /> _� 5 I h 1�� <br /> WELL AND SEPTIC PEFAIT RECORD$ARE AyAILAsLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PAt - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses, contact <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 files exist. An appointment for review will be confimled <br /> approximately ten(10)days after receipt of application. The files will be held for a maimum 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 48-02-0% <br /> 11.14108 <br />