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11/30/2006 01:27 8189020 JMK ESI PAGE 01 <br /> 11 I MMED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH.DEPARTMENT 7� <br /> ENVIRONMENT HEALTH ; <br /> NOV 3 0 2006 304 Farr Weher Avenue, P Floor, Stockton, CA 95202-2708 /7 /.///Z � <br /> Telephone:(209)468-3420 ]Fax: (209)464-0138 Web: www.sigov.org/ehl, <br /> PERMIT/SERVICE <br /> nGil_ <br /> S <br /> L�n IPIWU�,,BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: L 11— lV m'Y1'1�` � BUSINESS/AGENCY: <br /> ADDRESS; ((yi�+',,I(tyWNl RYti' ty� v/�7 <br /> PHONE(i): ill D" ��"l�00 10 1 gio PHONE(2): FACSIMILE: N!` OV o <br /> TENTATIVE'APPOINTMENT DATE: VW• II, Zt � rime: ��- <br /> (Please allow 10 business days from date of application submittal-'rentaeve only-must be confirmed) <br /> 173 CHECK BOX TO EXPEDITE REQUEST-$96.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �« ' DATE 11 OG <br /> UNITDISTRIBUTION ❑ Unit1 DUnit 2 ❑Unit 3 4Unit 4 0Unit 5 M Units ❑ Other(electronl tsimaps) <br /> FILE ADDRESS EHP USE O Y <br /> Street# Street Name Ctty <br /> 2. <br /> 3_ _ <br /> 4. \ <br /> 6. d <br /> 7DEC. <br /> 8 fiO <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> f/ ENVIRONMENTAL. HEALTH DEPARTMENT FILLS ' <br /> r�UNDfiaGnOUND TANK(UST)CLEANUP SITE(LOP) LJHOUSING ABATEMENT R<UD WASTE FACIUTYMHIC <br /> THED CLEANUP SITE(NON-1.015) rI FWD FAmLny 0 WASTE TIRE `{ <br /> EYNDERCROUND TANK(MONITORINGIREMOVAL) ❑ DOG KFNNEL 0 RY ` <br /> Ja HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ASTEWATER TREATMENT PL NT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCKIYARDICNEM I IILETS <br /> 0 TATTOOBODY PIERCING 0 POOLISPA P-LAND USE APPUCATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RZMEW- MONDAY-FRIDAY 8:00 AM-5;00Pe . 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 MOM 464-0138 or mail to the address <br /> Indicated above. Address rdnge5 will not be accepted—for additional assistance with file addro spec,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 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 reviow. 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 /> applicartL Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHO�e.66 <br /> Wl06 <br />