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Nov 28 05 03:26p Apex 2( X67-9668 p.1 <br /> NOW <br /> EIVED E]iD LOG NUMBER <br /> «3 U\ SAN JOAQUIN COUNTY <br /> ENMONUMNTAL HEALTH DF.i ARTmENT <br /> 40V 2� 304 East Weber Avenue,3d Floor,Stockton, CA 95202-2708 U <br /> Telephone:(209)468-3420 Fax:(209)464-0I38 Web:www.sjgov.orgfehd <br /> T- i mEALM <br /> RNES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t7 ram Q W 11 eh l3USINESSIAGENCY•__ -04- <br /> ADDRESS: Vfo -r'%r t- t'k k73V t <br /> PHONE(1): PHONt(2): FACSi 9_F_— 1P (a i o^ Q C 4 <br /> TENTATIVE'APPOINTMENT DATE rg&a1 L 1 `dam time: Q <br /> (Pt me allow 10 business days from date of application submittal-'Terrdaffve only-must be confirmed)'— <br /> ( CHECK BOX TO EXPEDITE REQUEST.:93.00 FjEECASH OR CHECK ONLY)-REQUEST PROCESSED IN 3USt DAYS <br /> SIGNATURE OF APPLICANT �IM'•^�-�+/�'` DATE I1 AZAIA) <br /> UNIT DISTRIBUTiOfif D Unft 1 13Un1t 2 ❑Untt 3 Unit 4 E 3 UrYt 5 D Unit S 0 Other(electroniellistshmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> street>a Street Name City <br /> 2 a'L �1� (.M.K. Siatx. -+ 'ZG V ion <br /> 1 LS 5 Z q <br /> 11c,! S7,a velew" s <br /> 5, , S 4 tK. <br /> 6. 4(%S t' IL I-D /_11" OM/-- <br /> 7. 'S%II N S4,&cL)4-w <br /> 8. I?- o.r► S tiG -_ n <br /> 34 Y 3.et t t4- <br /> 10. S- Do S -�, - <br /> Specific Date Range of Information Requested:From to 4J t> u-4- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> *immmmuNDTANK(UST)CLemuv SrE(LOP) 13 HousING Aa^Temew 0 Soup WASTE FAcuATT/YEHicLE <br /> 13 OTHER CLEANuP SITE(Nott-Lop) 13 FOOD FACILITY 0 WASTE TIRE <br /> 0 UNDUCROUND TANK(MONITORINWREMOVAL) 0 DOG KENNEL 13 DAIRY <br /> ❑HAmRoous WASTE GENERATOR O CHICKEN RANCH E_7 wAsTewATmTREATMENT Ptah, <br /> G Tam=PERraTTED FAauTr a MOTELIHOTEL f3 PUMPER TM)CWYARDICHEM TOUXM <br /> 13 TATTOOIBODY PIERCING 0 POOLISPA 0 LAND USE APrucAMON Srce3 <br /> C3 itEDICAL WASTE FACILITY D OTHaa(PLF-asE SPEgFY} <br /> WELL.A!D SEPTIC PERMT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY FRIDAY 8:00 A":OOPM - EXCLUDING HOLDAM <br /> 1. List up to ten addresses in the space above. Select the type(s)of files front the rest 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 atter 3:00 pm wig 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 EHO 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 nmy require a$93.00 deposit prior to review. <br /> ERD 4402.006 <br /> 1114105 <br />