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--- 1.1441/2005 11:21 FAX 916 638 £ DELTA ENVIRONMENTAL <br />[a 002/OC2 <br />DATE REIrEIVEDNUMBER <br />- <br />§AN JOAQUIN COUNTY r MEHb ioc <br />ENVIRONMENTAL HEALTH DEPARTME <br />_ 12005 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />E ' Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:rN-w-A,.sjgov.org/ehd a <br />a <br />APPLICANT: <br />ADDRESS: <br />mi �.fui <br />3t(a (9a1� <br />PUBLIC RECORDS RELEASE APPLICATION <br />iai11L, Stititi Zoo <br />_ BUSINESSIAGENCY: f4flf"- �nV;e0'grr1 UliC(- <br />kdNc,,' &A 96 70 - OV <br />PHONE(1): 1114 43$ - PHONE (2):5/1.1 <br />FACSIMILE: SIU &�O-t31s <br />TENTATIVE* APPOINTMENT DATE: III 111 u05 Time: q.'ib At— <br />(Please allow 10 business days from date of application submittal-'Tentatfm only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT r_ DATE _ )it 01! -to $ <br />UNIT DISTRIBUTION <br />❑ unit 1 ❑ U nilAgNiUnit 4 CO Unit 5 ❑ Unit 6 ❑ Other (electronic/lists/maps) <br />Street # <br />FILE ADDRESS EHD USE ONLY <br />Street Name City <br />1. 23 1 T <br />6ekAk-inn— (�o priG l.. H <br />2. <br />G <br />3 <br />1� <br />4. <br />5. <br />/ <br />7. <br />9. <br />10. <br />Specific Date Range of Information Requested: From M4 to P(LCSen� <br />J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Id UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING A13ATEMENT ❑ SOLID WASTE FACILrrY1VEHICLE <br />❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />RrHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT <br />❑ TIERED PERDAITTED FACILITY ❑ MoTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOOBODY 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 6:00 AMS: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 <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 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 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 48-02406 <br />1114W <br />G) <br />