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06/01/2005 17:35 53067' '95 STRATUS NO CALT— PAGE 01/0 <br /> DATE RECEIVE[) SAN JOAQUIN COUNTY <br /> �L <br /> ENVIRONMENTAL HEALTH DEPARTMENT t <br /> 304 East Weber Avenue,3d Floor, Stockton,CA 95200$1 t�a 2 PM 4. 3 � t <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.s o <br /> A <br /> PUBLIC RECORDS RELEASE APPLICAT OtIUIP: COUWTY <br /> ,C HENT <br /> APPLICANT: ewr ka,�r} BUSINESSIAGENCY: r <br /> ADDRESS: -^' - SD n <br /> - • <br /> PHO14E(1): (530>676- �QQ1 PHONE(2): 530 - FACSIMIIL� <br /> TENTATIVE"APPOINTMENT DAT <br /> (Please allow 1( business day r p n sub -'Y ' e only-must be confirmed) <br /> 6/CHECK BOX TO EXPEDITE REQUEST 93.00F /CASH O CHEC 0 Y)- QUEST PROCESSED IN 3 BUSIN SS DAYS / <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit1 10 Unit O Unit 13 Unit M Units O Unit 0 Other(electrnnicAisWmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street It Street Name City <br /> 2. AXA <br /> 3. 2 <br /> 4. -L <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to Fres a nil <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> W NDERGROUND TANK(DST)CLEANUP SITE(LOP) C HOUSING ABATEMENT O SOLID WASTE FACILfttfVEHICLE <br /> VCCTHER CLEANUP SIM(NON-LOP) C3 FOOD FACILITY 0WASTE TIRE <br /> r�y{r sRGROUND TAW(MONRORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> M IINARDDUs WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWTRUCKrEA DICH PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTELIHOrEL 0 PUMPER71 TRUGK/YARn/CHEM TOILET.+ <br /> TATTOOIBDDY PIERGING ❑PDOUSPA ❑LAND USE APPLICATION SITE& <br /> MEDICAL WAST FACIDTY O OTHER(PLEASE SPECIFY) <br /> WELL ANOSEPTtO PERMIT RECORDS AREAVAILARI-EFOR REVIEW- MONDAYFMOAY B'OD AM-5:00FM - EXCLUDING HOLIDAYS <br /> - <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 '20 1464-0138 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 fife 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 /> END a42-0W <br /> IIIV <br />