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12/30/2005 08:11 FAX 510 420 9110 CAMBRIA 1A001 <br /> vnlG RCI.CfVCU <br /> SAN JOAQUIN COUNTY EHD(_OG NUMBER <br /> ������ '��\� � 304 ENVIRONMENTAL HEALTH DEPARTMENT <br /> East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Ute �: <br /> LQ�`J Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 153o <br /> s, 1j I HE[,JH PUBLIC RECORDS RELEASE APPLICATION <br /> APii IL�4�li}iT,I BUSINESS/AGENCY: <br /> ,�{ y✓wc �/� . wleyeS�Gu <br /> ADDRESS: <br /> PHONE(1): :5-1- IlZo TS4,ct PHONE(2): <br /> // FACSIMILE: .57o2!<! <br /> TENTATIVE*APPOINTMENT DATE:,/.4r/u �3 Zooms Time:oyoc> <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE RE UEST-$93,00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electron ichists/maps) <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 1. eZ%2o Et a,2 a ra.+e <br /> 2. z5 is- E aoe z sra <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. _ <br /> Specific Date Range of Information Requested:From _Au. >ti"Zr'.- to <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> J� NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIL(TY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) Q DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACIu1Y ❑MOTEL/HOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑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: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 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. <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 fifes 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 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 /> EHD 48-02-006 <br /> VW05 <br />