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11 -Jan -2006 02:25pm <br />rrnn YE RECEIVED <br />I V� <br />ADDRESS: <br />PHONE (1): <br />From-Younadah0gultins Group Inc 916 933 6482 0 T-232 P.001/001 F-779 <br />SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 �v Q <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orVebd <br />PUBLIC RECORDS RELEASE APPLICATION <br />— UV 6 � PHONE (2): <br />TENTATIVE` APPOINTMENT DATE: Time: — <br />(Please allow 10 business days from date of application submittal - Tentaffn only - must be confined) <br />CHECK BOX TO EXPEDRE RE T-$93.00 EE ( R CH K ONLY). REQUEST PROCESSED IN 3 BUSINESS <br />SIGNATURE OF APPLICAN DATE <br />UNR DISTRIBUTION D � <br />9peClfie Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />1NDERGROUND TANK (UST) CLEANUP SnTE (LOP) M HOUSING ABATEMENT M19OUD WASTE FACIUTYAIEHI M <br />ER CLEANUP SRF (NON -LOP) ❑ FOOD FAGILRY D WASTE TIRE <br />nDEROROUND TANK (MONITORW W REMOVAL) E3DOG KENNEL ❑ DAIRY <br />HAZARDDVs WAsrE GENERATOR ❑ AN <br />CHICKEN RCH E3WASTEWATER TREATMENT PUNT <br />O TIERED PERMnTED FACILITY O MOT13JHOTEL ❑ PUMPERTRUCKrYARD/CHEM TOILETS <br />0 TATroo/Bo Y PIERCING 13POOVSPA Cl LAND DSM APPLICATION SMEs <br />O MEDICAL WASTE FAaLny 0 OTHER (PLEASE SPECI <br />LLANFY) <br />WEOSEPTICPERMRRECORQ4 AVML LEFORRMgf,W - MONDAY-FRIDAYS:DOAMS:DOPM • E%cWDINGHOLIDAYS. <br />1. List up to ten addresses in the space above. Select the types) 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 wilt 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 aoDlicant may rpmrim n cat nn se.,..es ...:,._... .....:..... <br />CND Q42QOS <br />1,1"5 <br />4 <br />INME <br />9peClfie Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />1NDERGROUND TANK (UST) CLEANUP SnTE (LOP) M HOUSING ABATEMENT M19OUD WASTE FACIUTYAIEHI M <br />ER CLEANUP SRF (NON -LOP) ❑ FOOD FAGILRY D WASTE TIRE <br />nDEROROUND TANK (MONITORW W REMOVAL) E3DOG KENNEL ❑ DAIRY <br />HAZARDDVs WAsrE GENERATOR ❑ AN <br />CHICKEN RCH E3WASTEWATER TREATMENT PUNT <br />O TIERED PERMnTED FACILITY O MOT13JHOTEL ❑ PUMPERTRUCKrYARD/CHEM TOILETS <br />0 TATroo/Bo Y PIERCING 13POOVSPA Cl LAND DSM APPLICATION SMEs <br />O MEDICAL WASTE FAaLny 0 OTHER (PLEASE SPECI <br />LLANFY) <br />WEOSEPTICPERMRRECORQ4 AVML LEFORRMgf,W - MONDAY-FRIDAYS:DOAMS:DOPM • E%cWDINGHOLIDAYS. <br />1. List up to ten addresses in the space above. Select the types) 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 wilt 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 aoDlicant may rpmrim n cat nn se.,..es ...:,._... .....:..... <br />CND Q42QOS <br />1,1"5 <br />