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10/23/2007 09:23 2133800505 ENVIRONMENTAL PAGE 01/01 <br /> 7-, <br /> 1_1 EHD L05 NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> 2607 ENVMON-NWNTAL HEALTH DEPARTMENT <br /> -ao <br /> d <br /> Tole 28/1, 773 <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 9520 <br /> Telephone:(209)468-3420 Fox;(209)4W138 Web: www. <br /> PUBLIC CORDS RELEASE APPLICATION <br /> PUSIN <br /> I ESSIAGENCY; 0 <br /> APPLICANT: fro,(A A�C— <br /> �niTrOn/T en <br /> ADDRESS: 3;l,`iS \,,,Ji 15 <br /> PHONS(1): TM—CIIA -'3 PHONE(21: FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE' Time: <br /> (Please allow IQ business(lays from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REgUrST-$95.00 F ,REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 7 ECK ONLY) <br /> SIGNATURE OF APPLICANT DATE IQh4lo -I— <br /> Electronic Information: [fList[_ Map—Description: I <br /> FILE ADDRESS EHD USE ONLY <br /> street At Street Name City 0 unit I <br /> 1721. 1 0 unit 2 <br /> :3 <br /> 3. Unit 3 <br /> Unit 4 <br /> r4 ........... D units <br /> 0 Unit 9 <br /> 10. <br /> Speclilc Date Range of Information Requested!From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDRRGROUNDTANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT Q SoLaIWAsTE FAGILaYNEHICLE <br /> OTHER CLEANUP SITE(NONLOP) 0 FOOD FACILITY DWASTE TIRE <br /> UNDERGROUND TANK(MoNrrORINGWMOVAL) 13 DOG KENNEL L1 DAIRY <br /> HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH Q WASTEWATER TREATMENT PLANT <br /> TmHao PERMITTED FACILITY In MOTELIHOTEL C3 PUMPER TRVCKIYARPICHEm TuiLeTa <br /> TATTOO/800Y PIERCING 1:3 POOLISPA El LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE$PECIFYI <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FlUDAY13:00AM3;IKIPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ton 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(2091404-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applicallons received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ton(10) <br /> days after receipt of application. The files will be hold 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 now 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$96.00 deposit prior to review. <br /> EHD USE ONLY <br /> I <br /> EHD 4 08 OAWON <br />