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MAR-16-2007 08:26 T�RRACON — ROSEVILLE 916 784 3487 P.01i01 <br /> r DATE R�EIS\` ED <br /> D, ` �/ SAK JOAQUIN COUNTY EHD LOG NUMBER <br /> �� D ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> !' ���� Telephone:(209)468-3420 Fax: (209)464-0138 Web: wwwsjgov.org/eh <br /> ZES <br /> �NVIRUiviL'iCIJ I �iEALI H PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: - BUSINESS/AGENCY:l'1wMCC*" <br /> ADDRESS: VA. "15 Q f <br /> PHONE(1)= �1 •� PHONE(2):_ FACSIMILE:91(at Sq, 340h <br /> TENTATIVE"APPOINTMENT DATE: 6/1�/O Time:(v->C) <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 -� 1 - DATE - <br /> Electronic Information: ❑ List❑Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 8troet# Street Name �— City _ ❑ Unit 1 <br /> F2. <br /> lol nI 11� 5i�c ,Y�� I ❑ Unit 2 <br /> 11111le <br /> unit3 \ <br /> 4. <br /> 5. _ - I U,;4 <br /> 6. { <br /> L10.7. _ _ [� Unit 5 <br /> 9. Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT _,ATSO io WASTE FACg1TYNEH ICLE <br /> ❑OTHER CLEANUP SITE(NDN-LOP) <br /> d FOOD FACILfrY 0 WASTE TIRE <br /> � INpERGROUND TANK(MON1T=IG/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> 1AZARDOVg WASTE GENERATOR 0 riNICKFIJ RANCH 0 WASTEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FAC{uTY ❑MOTEUHOTEL PUMPER TRUCK/YARDJGHIEFI TOILETS <br /> ❑TATTOO/BODY PIERCING 0 POOLISPA Cl LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REviEw - MONDAY-FRIDAY 8:00 AM-5:0015M - 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 209 464-0138 or mail to tip address Indicated a ove. 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 /> FHD48AL 8/t34006 <br /> TOTAL P.01 <br />