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MAY-01-2007 16:08 �ACON - ROSEV I LLE 916 784 3487 P.01/01 <br /> QATEREC6IYED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> - ENVIRONMENTAL HEALTH DEPARTMENT <br /> 70 <br /> t 304 East Weber Avenue, 3fd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web: 060q7 <br /> /eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Acc"&L�iBUSINESSIAGENCY: <br /> ADDRESS:. Lf b - ��5+1 <br /> 6��C , <br /> PHONE(1): t'6—-7 31 - 2 $3 PHONE(2)' 9116- FACSIMILE: 1914- -Y64-64191 <br /> TENTATIVE*APPOINTMENT DATE: T_— Y . 2--DO-7 Time: 4944 4Y &AJOP-N►Is h <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> © CHECK BOX TO EXPEDITE 7REQU 95.00 (C R •REQUEST PROCE$$ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT CH O <br /> DATE ' ( ` c' <br /> UNIT DISTRIBUTION IM Unit 1 C1 Unit 2 0 Unit 3 O Unit 4 C3 Unit 5 ❑ Unit 6 ❑ Other(*Is*Vonic4isWmaps) <br /> FILE ADDRESS _ EHD USE ONLY <br /> - street# street Name { city <br /> 2. <br /> 4. <br /> 9. <br /> FITT <br /> Specific Date Range of Information Requested.From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES k, <br /> ,UNDERGROUNO TANK(UST)CLEAO HOUSING ABATEMENT O SOLID WASTE FACILITY NE LE <br /> -OTHER CLUM P$ITE(NON-I. NUP SITE(LOP)OP) ❑F000 FACILITY In WASTE TIRE <br /> YWNDERGROUND TANK(MOMTORNGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> PhiAZARDOUS WASTE GENERATOR M CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTELIHOTEL O PUMPER TRucWYARD/CHEM TOILETS <br /> 17 TATTOWBODY PIERCING 0 P0001SPA E3 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY Q OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE mKREVIEw- MONDAY-FRIoAY 9:00 AM-5:00PM • ExmumMa HOLFOAYS. <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. F&X to(2211 M4-0J35 or mail to the adorm <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 fife 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 require a$95.00 deposit prior to review. <br /> EHD�i-06 <br /> WO <br /> TOTAL P.01 <br />