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06/01/2005 17:35 53067f� 95 STRATUS NO CALT— PAGE 01/0 <br /> DATE RECENED L G <br /> SAN JOAQUIN COUNTY ✓ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor, Stockton,CA 9524 '�ji <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:WWW-1SX Art PHOA <br /> :his <br /> PUBLIC RECORDS RELEASE APPLZCA VIRQUIN COUNTY I I . <br /> r 1, HNT l <br /> APPLICANT: Ge w I y%,f r BUSINESS/AGENCY: <br /> ADDRESS: <br /> PHONE(1):(530 6'76— ko) PHONE(2): 53a - FACSIMMIS,, J <br /> TENTATIVE*APPOINTMENT DAT <br /> (Please allow 10 business day t p n sub �j-•Y only-must be confirtaed) <br /> CHECK BOX TO EXPEDITE REQUEST 93.00 F CASH O CHEC OGLIn- QUEST PROCESSED IN 3 SUSIN SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION Q Unit 1 t]Unit 2 a Unit 3 M Unit 4 la Unit 5 O Unit 6 0 Other(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 Street Name City <br /> 1. 2 C..- <br /> 2. <br /> 3. 2 <br /> 4. 2 <br /> -706 <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to fres#.A-1- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> WPMERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT O SOLID WASTE FACILITYNEHICLP <br /> I OTHER CtEANUP SITE(NON-LOP) O FOOD FAuuTY C3 wAsm TIRE <br /> =,{J'NDERGROUND TANK(MONMORING/REMOVAL) E3 DOG KENNEL d DAIRY <br /> t RpplJS wASTl:GENERATOR 0 CHICKEN RANCH O WAsTEwATE t TREATMENT PLANT <br /> O TIERED PERZNTTED FACILITY 13 NIOTeL/I arm ❑PumPER TRucMARo/CHEu TOILETS <br /> ❑TAr=/BODY PIERCING 11 PoOL/SPA C3 LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY t7 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AMZ:Q0FM - EXCLUDING HOLIDAYS. <br /> 7. 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)464-0738 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 /> END 4E-02-006 <br /> 1114= <br />