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Oct 03 05 11:26a Drew Van Allen —. 20967-9668 p.1 <br /> DAJE RECEJVW= ` ) EHD LOG NUMBER <br /> SAN JOAQM COUNTY <br /> ENNgRONIbIENTAL HEALTH DEPARTMENT <br /> �- 304 East Weber Avenue,3rd Floor, Stockton, CA 95202-2708 <br /> t t Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orl/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 4r{� Or �l�(� BUSINESSIAGENCY:_ <br /> ADDRESS: Z�� ^ '�-� ���..-L T�floff+ . 'A <br /> PHONE(1): ZI Q LIB -��o�?' PHONE(2): n F lob-- CCI FACSIMILE: Z"'�:, <br /> TENTATIVE'APPOINTMENT DATE: t,% lV1OS7- Time: 01 _3c� <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-`$ 3.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT �---" - GATE ��75 aa^ <br /> UNIT DISTRIBUnON ❑ Unitl ❑Unit2 ❑Un Unit 4 Unit 0 Unit Cl Other(electronlrJUstslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street d Street Name City <br /> JJ4 ro 4 •mak Ca <br /> 2. f 57 . '-1 dOdo� <br /> 3. al d cry r+ <br /> 4. �c�{1 Cltioi f�r trio. S�.La< <br /> gl ,f���%4D S4-. <br /> 6. ��(dZ v c. e n•�t S �n� <br /> i. Iffl33 CV.p r)w via ��ti�a <br /> 8. 3Zza N �I�- Lam c <br /> 9. ZaaS <br /> Specific Date Range of Information Requested:From to �. �► <br /> �,�+ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .Q�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOuo WASTE FACILITYNEHCLE <br /> ❑OTHER CLEANUP SJTE(NON-LOP) 1]FOOD FACL.I Y ❑WASTE nRE <br /> 13 UNDERGROUND TANK(MorUTORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOWBODY PIERCING O POOUSPA 0 LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPric PERMIT RECORDS ARE AVAILABLE TOR REVIEW . MONDAY•FRIOAY 8:00 Am-6:00AM - 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 END 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 48-02-005 <br /> 1yU05 <br />