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- Jul.13. 2006 2:53PM A01ced GeoEnvironmental46 :No.5480. P. 1 <br />DATE Htut:ivEO SAN JOAQUIN COUNTY =HD Lvv..UMBER <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3rd Floor; Stockton, CA 95202-2709/ <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/chd <br />PUBLIC RECORDS RELEASE APPLICATION ✓ <br />APPLICANT:,�U ,ry Y1 ( 11 y�e� ^ r'y�� BUSINSS(S�IAGENCY: 1I . <br />ADDRESS: _ iS I._ JI_ �a. ,. SIV CX U� C7 QSAI S <br />PHONE (f): at U 7 - Y (0 -/ -I U'U CO PHONE (2):XQ/Of— C ` / W 7 FACSIMILE: aU 7 " W- (` I I ('T I <br />TENTATIVE` APPOINTMENT DATE: I7 n JV 1y 4010 6? C0y Time: /6-0,0 i) r— (I � <br />(Please allow 90 buumms days from date of application submittal-'Tentadve only -must be Confirmed) <br />CHECK EOx TO EXPEDITER InST - $93.00 FEE (C OR C,VErtCK, ON,LY,)�-, REQUEST PROCESSED INr3 E SINES^ GAYS 1 <br />SIGf�1TURE OF APPLICANT d-tA,4 l - DATE / d <br />UNIT DISTRIBUTION nUnit EfUnit2 nUnit 3 nUnit 4 nUnit 5 n Unita D Other(elecoonlenists/maps) <br />rla_trretNameo� EHDUSF�GNLY ! <br />Sheat t Street Name Cigt <br />I t <br />!I <br />N <br />KI 'v I n[ 5 y v L rte" I v'4- I 1714&r2u <br />�.. <br />�Oifi <br />pecc Date II of Information Requested: From '1PQ r7 to _�� <br />nt�i[ Dnl� ENVIRONMENTAL HEALTH DEPARTMENT FILES - a.'W <br />UNDERGROUND TANK(UST) CLEANUPSITE(LOF) <br />O HomiNo ABATEMENT <br />0 SOLID WASTE FACILITYNEHIOLE <br />OT HER CLEANUP $r"' <br />E(NON-LOP) <br />n FOOD FACILITY <br />❑ WAa'rE TIRE <br />NDERGROUND TRNK (MONI70RINGlREMOVAL) <br />❑ AOG KENNEL <br />r] DAIRY <br />HAZARbOU$ WASTE GENERATOR <br />17 CHICKEN RANCH <br />M WASTEWATER TREATMENT PLANT <br />C] TIERED PERMITTED FACILITY <br />0 MOTELIHOTEL <br />til PUVPER TRUCWYARDICHEM TOILETS <br />❑ TATTODIBODY PIERM40 <br />0POOLISPA <br />WL4N0 USE APPLICATION SITES <br />El MEDICAL WASTE FACILITY <br />0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW , MONDAY -FRIDAY 8:00 AMS:OOPM - 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 pox(ea). At least one file type MUST be selected. Fax to 2091464-0138 or mall to the address <br />indicated above. Address ranges will not be accepted -for additional assistance with file addresses; contact <br />the EHD. Applications received aft9r 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 review. A new <br />application'tbay be submitted when the file is available. <br />4. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expense of the <br />applicant. Future file roviews by the same applicant may require a $93.00 deposit prior to review. <br />'•'rte-- <br />EHD 48,02400 <br />tMN0 <br />