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Apr 1"_ 5-04A6p Drew Van Allen° 20n )67-9668 p.1 <br /> DATE RECEIVED EHD LOG NUMB <br /> APR 1 2005 SAN JOAQUIN COUNTY <br /> F,NVIRONMENTAL HEALTH DEPARTMENT <br /> E1, 'r'ONMEN 1 i I i;'_r!-4 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> 6' r{1M.1�-�`;'_= Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: f`f srl Ca t <br /> BUSINESS/AGENCY: A_Z�tx <br /> ADDRESS: Z U�-• i �r�vc. r,��;oLK CF `tS3� <br /> PHONE(1): (o(o�-� ��'�`I PHONE(2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 3S Time: g%n <br /> (Please allow 10 business days from date of application submittal-'realaffve only-must be confirmed) <br /> C3 CHECK BOX TO EXPEDITE REQUEST,-x$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT b DATE 4'8��S <br /> UNIT DISTRIBUTION 0 Unit 1 ❑Unit 2 ❑Ulf 3 Unit 41 D Unit 5 4 Unit 6 0 Other(e(ectronidlistslmaps) - <br /> FILE ADDRESS <br /> saver* Street Name city EHD USE ONLY <br /> 1- �rV'ON}`INL <br /> 2- 3 fie~ G�la� S Ck n1 y <br /> 4. tco <br /> S. a�Cs IM a 11'i <br /> t. Slvc►. a� <br /> 7. (So t <br /> 8. <br /> 9. <br /> 10. 3-x-55 >t i,� �q•�t. S�ct� <br /> Specific Date Range of Information Requested:From 7-.C:kr-3 to `L�5 —CJJ4-P_--f- <br /> �,/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> +z(UNDERGROl1ND TANK(UST)CLEANUP SITE(LOP) ❑HOUS WG ABATEMENT O,SOLID WASTE FActuTrNEHCLE <br /> 13 OTHER CLEANUP SITE(NON-UOP) ❑Fooc FACILITY <br /> WASTE TIRE <br /> 0 El DOGUNDERGROUND TANK(MONITORINGIREMOVAL) -KENNEL ❑ <br /> C3 HAZARDOUS WASTE GENERATOR13 E3DAIRY <br /> C3 TIERED PERMITTED FACILITY CHICKEN RANCH Cl WASTEWATER TREATMENT PLANT <br /> 13TATTOWB0DY PIERCING ❑UOTEUHOTEL C3 PUMPER TRUCKIYARDICHEM TOILETS <br /> t3 1IIEDICAL WASTE FACILITY ❑POOLISPA 17 LAND USE APPLICATION SITES <br /> 17 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - 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 riot 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 445-02.006 <br /> I M4106 <br />