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Nov 28 05 03:26p Apex 667-9668 <br /> I,1iRECEIVED _. <br /> SAN JOAQUINCOVNTY <br /> iia LoclvuMt <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 40V " `0 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 <br /> =1) " Telephone:(209)468-3420 FAX:(209)464-0138 Web:www.sjgov.org/ehd <br /> -ANDES PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT: !Drew Qw A tl to BUSINEssrAGEHCY: ) <br /> ADDRESS: Z"?'0 )-A4,. p r1 v-tr <br /> PHoNE(a): P14ONt(2): t AcslaltcE <br /> TENTATIVE"Appaw MmT DoT 1 Itj f � .ire Q <br /> (Please allow 10 business days frorn dabs of appllcatlon submittal-•Tune only-must be Conflnned)'� <br /> [3 CHECK BOX TO EXPEDITE REQUEST- 93.00 F�EE,�[CASH OR CHECK <br /> ONLY) REQUEST <br /> E I1N 13 Zu4stt rQ.a sSIGNATUREOFAPPUCANT DATE <br /> � <br /> UNIT DISTRIBUTION Qa <br /> unit 1 t7 Unit 2 t]Unit 3 Unit 4 E3 UNt 5 E3 Unit 8 O Other(eleCb%"CJllstehnaPs) <br /> FILE ADDRESS <br /> Street 4 Street NameGity EHD USE ONLY � <br /> � � <br /> 2 O Z, .9!4. L4rFR. Si.,,t.K. -► a6 Y <br /> 1Z5 S erg A S <br /> s. /mos l' . r�..o. I► a c•. Ona�- <br /> 7. tk. -A / j <br /> 34 T3. G% a r-f t� <br /> 10. S. Do S <br /> SPGCMC Date Range of Information Requested:From to LJ f rL44- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 116NDERGMUNDTANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT E3 SOUDWAgTF FACUnlVEHICLE <br /> E3 OTHER CLEANUP SITE(Nott-LOP) 13 FOOD FACUTY 13 WAM TRE <br /> E3 UNDERGROUND TANK(NLCN TpRING1REMOYAL) Q DOG KEmtm ¢DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR D CHICKEN RANCH 13 WASTEWATERTFteATMENT PLAMT <br /> C3 Tkmw PERMI., FAc3uTY G NOTEUNoTEL O PUMPER TRUQUYARWC HEM Tou.Ets <br /> E3 TATTOOIBODY PIERCING 13 PooL1SPA 13 LAND USE APPLICATION SRW3 <br /> E31111MCAL WASTE FAOIt17Y C3 OWER(PLEASE SPECIFIfj <br /> WELL AND SEP=PERM r RECORDS ARE AVAIL AME FOR REVIEW- NbkDAY--FWDAY 8:00 A":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 avaitable 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 /> EUD49-02 ft <br /> IM4+95 <br />