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MAR.10.2005 10:59AN APEX ENVIROTECH,INC. NO.289 P.1 I <br /> DATE RECEIVED 1411/ EMD LOG NUMBER <br /> ( SAN JOAQUIN COUN'T'Y � <br /> � .,, l�� ENVIRONMENTAL HEALTH DEPARTMENT � <br /> 304 East Weber Avenue,3d Floor,Stockton,CA 95202-2708 ! <br /> MAR I 0 2005 Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> E ViRONWHT HEALTH PUBLIOI •RECORDS RELEASE APPLICATION <br /> A T: 0'"� �` -A BU31NES51AGENCY7 A�x PHONE(1):7M Leo f' Cc; '%IL PHONE(2): VC17 t�' 0b 41- FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: UA'N � Time: 04� <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST.493,00 FEE�(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Jt- --v rte"�- DATE 3 Ado$' <br /> UNiT DISTRIBUTION ❑ Unit 1 ❑Unit 2 M Un(t 3, Unit4 ClUnItS 0 Unit 6 Cl Other(eloctronicGlists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Streat Nance City <br /> 3. <br /> s. nsi✓ <br /> 6. X11 E� t4 '► '', ':,! �! h' <br /> 10. faY21 ham <br /> SpaCific Data Range of Information Requested:From to 'LOCk<­ Caj fir% <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,VIUNDERGROUND TANK(US'i)CLEANUP SITE(LOP) C3 HOUSING AeATEMF-NT A Sopa WASTE FAC MIVEMCLE <br /> E3 OTHER CLEANUP SITE(NON-LOP) l:7 FOOD FACILITY C3 WAST!'nRE <br /> C3 UNDPnROUNDTANK(MONITORING/REMOVAL) b DOGKENM ' 0 DAiRY <br /> ❑HAz&RDOUs WASTE GENERATOR 0 CHICKEN RANCH 1D WASTEWATER TREATMENT PLANT <br /> E3 TI!R!D PERMITTED FACILITY C1 MoTLUNonL ❑PumPERTRucK1YAR0/CHEM TOILETS <br /> ra TAT O'0[BODY PIERCING t7 POOL/SPA 0 LAND USE APPLICATION$ITEs <br /> MEDICAL WASTE FArAmy M OTHER(PL!ASESPECIM_ <br /> WELL AND SEPTIC PFRMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 0,00 AM•5:00Pia - 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 /> S. A file that is actively being worked on by EMD staff may not be immediately available for review. A new <br /> application may be submitted when the flie 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 /> I111.' -•.-•, .�-- „ <br /> !HO 411-02-WO <br /> 11114105 <br />