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MAR-16-2007 08!2y�6����/�\ RACON - ROSEVILLE 916 784 3487 P.01i01 <br /> DATE RECEIVED ��` • EHD LOG NUMBER <br /> � ��II\���(� �\G`� SAN JOAQUIN COUNTY <br /> r LDS ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`0 Floor, Stockton, CA 95202-2708 <br /> MSE!'; 6 9707 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh ]V` <br /> kNVIRUivrr 0 I, WPA N <br /> Pk PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C✓& BUSINESSIAGENCYITr�yrtA or% _ <br /> ADORESS: qq11 o S]k ,� I- ,r <br /> PHONE(1) ' .I PHONE(R) FACSIMILE:91(o•�16g, 3k8E <br /> TENTATIVE*APPOINTMENT DATE: 3/ji' /Q-t Trmo=I V?>0 <br /> (Ploase allow 10 business days from date of apphca0on submittal-'Tentative only-must ba confinnee) <br /> CHECK BOX TO EXPEDITE RE�QUES�T''-$96,�00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �J VS11ktAU DATE SZIIP1O- <br /> VV <br /> Electronic Information: [] List❑ Map- escription: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street 0 street Nama City ❑ unit 1 <br /> n I Ili _Sio y- <br /> 3.4. nit.. Unit3 <br /> 5. <br /> Un114 <br /> 1 . . <br /> 7. ❑ Unit5 <br /> 8. <br /> units <br /> 10, <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .A<NOERGROUND TANK(UST)CLEANUP$ITE(LOP) M HOUSING ABATEMENT �SOUD WASTE FAGTLITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) OFoOb FACILnY OWASTETIRE <br /> ,; GNOERGROUND TANK(MOMTORINGIREMOVAL) 11 DOG KENNEL O DAIRY <br /> 1AZARDOUS WASTE GENERATOR IJ CHICKEN RANCH r3 WASTEWATER TREATMENT PLANT <br /> *TIERED PERMITTED FACILITY 0MOTELiHOTEL O PUMPER TRUCKIYARD/CHEM TOILETS <br /> CI TATTOOIBOOY PIERCING ❑POOLISPA ❑LANo USE APPLICATION SITE$ <br /> ❑MEDICAL WASTE PACKUTY 171 OTHER(PLEASE SPECIFY) <br /> WELL AND SEFnC 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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address In icated above. Address <br /> ranges will not be accepted-for addlUonal assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHO will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> 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 applicant <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD"e ei�m <br /> TOTAL P.01 <br />