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03/16/2007 15:10 FAX Z002 <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH.DEPARTMENT <br /> MAR 3 6 2007 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONIVIEN1 hEALi t <br /> PERM7/SERV �ICES PUBLIC RECORDS RELEASE APPLICATION �1 <br /> APPLICANT: Ij i(- K'-' -k'-' 0.vh BUSINESS/AGENCY: (A.)Aa<.,,-K,(A 1 �A55 oGia�eS <br /> ADDRESS: 3HIU W•F.,,k.er �cw�e.S�lsF 56,1--6A .GPC 9521q <br /> PHONE(1): (2c'�) Z3'{ PHONE(2): (2A9) 234-7?27 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> EI CHECK BOX TO EXPEDITE RE T- 00 FEE(CASK OR EC ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE 3.11 b/07 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 1. q 515 W(L-A-C'r 10C 0 E S�aGk�w <br /> 2. q3iqq pafe� lob Unit <br /> 3. 4007 94 E L <br /> 4. Unit 3 <br /> • <br /> 5 755 lV Br���w�- Unita <br /> 5• I q05 Ntlr�1� �ppt p�✓� <br /> T• 00 a�Jn I `J�G4�N ❑ unit <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT M SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 17 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 17 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL 171 PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> 1-3 MEDICAL WASTE FACILITY ❑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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> submitted when the file is available. <br /> 4. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expense of the applicant- <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 9/13/2006 -_ <br />