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01/23/2006 15:20 FAX 1 209 234 7727 STOCKTON 1j001 <br /> DATE RECEIVED EHD LO3 NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 4Z 175 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web: www.sjg0v.or ehd <br /> 200b JAN 23 PH 3: 49 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: j7L BUSINESS/AGENCYy 56fG & t?C I Ct w�eS <br /> ADDRESS: ' `0 �2Gi'f 110-411 <br /> PHONE(1):L2OR)23t{—'t 9 &Z- PHONE(2): /41 b)$11'00575 _FACSIMILE: C1 ai <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> El CHECK BOX TO EXPEDITE REQUES $93.00 F (C OR HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT CIC_ DATE I 2 <br /> UNIT DISTRIBUTION ❑UdV1 ❑Unit 2 ❑ Unit 3 ❑Unit 4 0 Unit 6 ❑ Unit 6 13 Other(electronic/I'Ists/maps) <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name city <br /> 71 <br /> 2. <br /> 3. <br /> 4. — - - <br /> 5. �P <br /> 6. <br /> 7. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILRYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) [3 DOG KENNEL 11 DAIRY <br /> PKHAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERGNG ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> 171 MEDICAL WASTE FACILITY 13 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 addresse 3,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"-02-006 <br /> 1!14105 <br />