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pyo roc Dian r.alibi <br /> DATE( u+ 3���- ISD <br /> SAN JOAQUIN COUNTY _ v <br /> U1�IC 11 ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUi; - 7 2005 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 .��f <br /> Telephone: (209)468-3420 Fax: (209)464.0138 Web: www.sjgov.org/ehd (/ <br /> EMIRNN ENT HEALTH <br /> PERMfT/SFRVIRES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 i nck BUSINESS/AGENCY: e NcSQ� <br /> ADURESS: 11 C)A 7 - _ , 9S' R'7 <br /> PHONE(1): GI O 'a,��J t4k4Q-n'1 PHONE(2): 9I(p`3ro',1. -JIM FACSIMILF: CJI(a $(pa RI n _ <br /> TENTATIVE'APPOINTMENT DATE: 101 In) &5 Time: IDArYl <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be Confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION 0 Unit 1 ❑ Unit 2 Unit 3 Unit 4 Unit 5 Unit ii ❑ Other(eleetronicllists/maps) <br /> FILE ADDRESS EHD USE ONLY r / <br /> Street N Street Name City <br /> 2. <br /> l� k <br /> 3. <br /> -4. ( NI-,e A-AL,P is M L_5. - <br /> 6. <br /> 7. <br /> 9.18. <br /> 10. 1 - <br /> Specific Date Range Of Information Requested: From _ �.C�('S% to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ild UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT Mi SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NOR-LOP) ❑ FOOD FACILITY EJB WASTE TIRE <br /> UNDERGROUND TANK(MONITORINWREMOVAL) ❑DOG KENNEL 0DAIRY <br /> y.HAZARDous WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 1$..TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑ PUMPER TRUCKIYARO/CHEM To4ETS <br /> 13 TATTOOIBODY PIERCING O POOLMPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY CI OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AwS: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 /> Eno aeasnas �- - - <br /> U1476 <br /> TOTRL P.81 <br />