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06/27/2006 10:53 FA% -- X1002 <br /> EHD LOG 14UMBEER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENvmoNMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3`d Floor,Stockton,CA 15202-2705 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd � <br /> 7500 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:� G BUSINESSIAGENCY: 1 '- — �t�<.. <br /> ADDRESS: -fZuP1' <br /> PHONE(1): !D 2AS-11" PHONE(2): FACSIMLE: C"!A L��"�. 1-4-Z;3L <br /> TENTATIVE*APPOINTMENT DATE: Time: - <br /> (PIme allow 10 business days from dace of appiimtlon submittal-'Tentative only-must be con5nmd) <br /> CHECK BOX TO EXPEDITE R U -$93.00 FE (C R HECK ONLY)•REQUEST PROCESSED IN 3 BU$INESP DAYS / <br /> SIGNATURE OF APPLICANT DATE 1. 1 Q 6 <br /> UNIT DISTRIBUTION tl unit Unit 17 Un11:3 M UnR4 ❑Units O Units 13 Othsr(electronldlists/maps) <br /> _ FINE ADDRESS _._ EHD USE ONLY <br /> Street It Stmele Namecity_ <br /> "AA414 ... j,ji,1^ .._._.�...__ ' 1`VG1G N. . _ . ----- <br /> 2. <br /> 4. 141'L _ Pkv M lit��a.>w1---__ MVC4C.3CDId <br /> s. 14410 aArM <br /> 7. M <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILITYWFJ4CLE <br /> OTHER CLAANUP SITE(NON-LOP) ❑FOOD FACIUTY 0 WASTE TIRE <br /> UNDERGROUNDTANK(MONIToFjNe1REM0VAL) Q DOG KENNEL ©DA1RY <br /> HAZARDOUS WASTE GENERATDR iO CHICKEN RANCH ❑WASTeWATERTRr-.ATmENT PLANT <br /> TIERED PERMnTED FACILITY 13 MOTEL/HOTEL ❑Pump m- TRUCKIYARWcHEM TOILETS <br /> 13 TA17OO/BooY PIERCING D PODLiSFA tl LAND USE APPL1cxnom SnEs <br /> 13 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AYAILABLB FOR REVIMV- MONMY-FRIDAY 8:00 Am-6:00FM - EXCLUDING Hout)AYS. <br /> 1- Llst 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 EHD 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 48-07406 z <br /> vm4ns <br />