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uul ua u i i m iia Apex 209 .667-9668 p.1 <br /> RECEIVES? EHD LOG NUMBER <br /> JOAQUIIN COUNTY `�+� <br /> EN VIROINmENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-27 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov, rg/ <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT:_ 4.A kkk-g, BUSINESS/AGENCY: Apex <br /> ADDRESS: 131 - C T.]vU� C1� S3e Z <br /> PHONE(1): PHONE(2)- FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Zo '07" Time: <)70C) <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City � ❑ Unit i <br /> 2• 1 (.39 f�, l�.gti..� S �c�cli �o2so 1d� ❑ Unite <br /> 3. SSSS Crl ��Q�n rn t r t a Ju s�C ko., <br /> 4. t)x ct r��ti Crlo $ tk� a l., A ❑ Unit 3 <br /> 5. ZZ-Z µa V1 i-,t cf S 4ac k�o✓� �� <br /> 6. qq<)-+` G. t,J C?�u Lnt, t2AC1 c� f�(K � Unit 4 <br /> S {o <br /> 7. <br /> $ ❑ Unit 5 <br /> 9. <br /> 10. ❑ unit 6 <br /> Specific Date Range of Information Requested:From Zyb3 to <br /> �J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ill UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEIi1CLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORINGIREMOVAL) ES DOG KENNEL O DAIRY <br /> E3 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY 0 MOTEL/HOTEL - ❑ PUMPER TRuCK/YARD/CHEM TotLETs <br /> I3 TAT-Too/BODY PIERCING M POOUSPA 0 LAND USE APPLICATION SITES <br /> 177 MEDICAL WASTE FACILITY ❑OTHER(PLEASESPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE ILA <br /> AVABLE 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(2D9)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 returned 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 4E-06 9I13r2W6 <br />