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05/03/2005 15: 13 FAX Q001 <br /> EHD LOG NUMBER <br /> DATi '2ECEIVEU SAN JOAQUIN COUNTY <br /> CE�W ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3Ta Floor, Stockton,CA 95202-2708 <br /> ,JAY 0 1 7005Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATIOQN� <br /> APPLICANT.• APPLICATION <br /> �1►aw EY1V1=ajjaf*0_ <br /> el ADDRESS: L116 't <br /> PHk>NE(1): 1 )-!�(l Z 3S`7 PHONE(2): FACSIMILE: <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 REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE $ - 3-05 <br /> E <br /> UN17 DISTRIBUTION 171 Unit 1 171 Unit 2 O Unit 3 ❑Unit 4 ❑Unit 5 ❑ Unit 6 11 Other(electronic/lists/maps) <br /> '' FILE ADDRESS USE O Y <br /> S Street 4 Street Name City <br /> "SNA» <br /> SUS 2. 76 _ - 'Vd <br /> 1 3. 0() ia <br /> 4. I; Corn Mneat4_1&Qr1>r <br /> _F. <br /> 7. <br /> LOLL <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> EI!'.•THER CLEANUP SITE(NON-LOP) <br /> ❑FOOD FACILITY ❑WASTE TIRE <br /> Cl!iNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0;j AIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH 0WASTEWATER TREATMENT PLANT <br /> C1 TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ FATTOCIBODY PIERCING ❑POOLISPA M LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - 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 <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. i <br /> f <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 l <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 /> t:41Ci8-02-006 <br /> 11 i d96 <br />