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-DEC. 13. 2005 i .03°M ,.,.DOR EARTH TECH 0. 4712 '. 2 <br /> l' lCFiti NUMBER <br /> DItR�ECEIVED <br /> SAN JOAQ M COL-I'rY s=' .: <br /> ]ENVII IDINMENTA.L MALTH DEPARTMENT � <br /> c0�0 1 304 East Weber Avenue,3'Floor, Stockton, CA 95202-2708 <br /> ENVIRO 1';Icid i i1LH flephone:(209)468-3420 Fax.- (209)464-0138 Web:www.sjgov.org/ehd <br /> PERIUlT ; RVirES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: cy BUSINESSIAGENCY: VITPM <br /> ADDRESS: <br /> OS1 2PHONE(1): 1 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date P on submittal-{Tentative only-must be confirmed) <br /> BOX TO Di a UEST-$93.00 E A CK ONLY)-P QUEST PROCESSED IN 3 B SI AY3 } <br /> CHECK - <br /> SIGNATURE OF APPLI DATE <br /> UNIT DISTRIBUTION ❑U41 a Unit2 O Unit ❑Unit ❑UnItS d Units 13 Ot1+er(alectronicllisGlmaps) <br /> FILE ADDRESS EHD USE ON Y <br /> street# Street Name Crty <br /> t32. .s <br /> . <br /> 4. 3 <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requestod:From <br /> �J/' <br /> ENVIRONMENTAL HEALTH DEPARTMENT ES <br /> 00�,INDERGROUND TANK(UST)CLEANUP srTE(LOP) �+ri0U9ING AaATFMEN 9 <br /> ouD WA3YE FAaurrNEH1 LE <br /> �}�ER CLEANUP SITE(NON-LOP) ❑FOOD FACR1 Y �Te TIRE <br /> ERGROUND TANK(MONrroRD1GIReWNAL) ❑DOG KENNEL ,�,j(]q�RY <br /> d HAzaPDouS WASTE GEuGRAroR El CHICKEN RANCH �+ 11WATeA TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY [O MOTM IC-EL 13 PPUUMPERTRuCKNARDICHEm ToILFTS <br /> d TATTOOI30DY PIERCING ❑POOLISPA D USE APPLICATION SITES <br /> C�`MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY a:00 AM-5:00rm - EXCLUOMG HOLIDAY$. <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 o,n 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 required$93.00 deposit prior to review. <br /> EHD 4"2.4" <br /> 1MAR1F <br />