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0510: 2005 10: 12 AM URS Corporation 4158829261 2 2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTII DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATIIION�� n _ _ <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: 2Q1 <br /> PHONE(1) S PHONE(2): FACSIMILE:/� �Y, <br /> TENTATIVE`APPOINTMENT DATE: Time: /,/, <br /> Y� C <br /> (Please allow 10 business days from date f pplication submittal-`Tentative only-must be confirmed) <br /> El CHECK BOX TO EXPEDITE R EST- 3.00 F ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 UI NESS DAYS <br /> SIGNATURE OF APPLICANT DATE J! QS <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronic/[ists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street l! Stree ame City <br /> F2. <br /> vt 0 f �. <br /> 3. <br /> 4. <br /> 5. -- <br /> 6. <br /> T. <br /> 8. <br /> 110. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> UTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 6:00 AM5:00PM - ExCLUDINO 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 <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 49-02-006 <br /> 1114105 <br />