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v 04/12/2007 13:51 209729 APERIC INC L V PAGE 02/02 <br /> DATE RFCEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ph East Weber Avenue, 3 ( 09)4 Stockton,b; mv.sjg2708 <br /> Telephone: (209)468-3420 Pax: (209)464-0138 Web:wwwsjgov.orpJe <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��f 0 �✓e, J � BUSINESSIAGENCY; <br /> 112 <br /> ADDRESS: --7---�— <br /> PHONE(i): 7ri'0"-3©75 � FACSIMILE:- <br /> TENTATIVE"APPOINTMENT DATE: 7 Time: I_��11 — <br /> (Please allow to business days from d to of application Submittal-"Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQU T-SS EE( OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unl ❑Unit 2 0 Unit 3 CI Unit 4 ❑ Unit 6 13 Unit 6 ❑ Other(electronidllstslmaps) <br /> FILE ADDRESS EHD USE O Y <br /> Street R Street Name city <br /> eo <br /> 2. <br /> 3. <br /> 4. 'h <br /> 6. \� <br /> S. <br /> 9. <br /> 10. p <br /> Specific Date Range of Information Requested:From _ L �� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDEROROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT iSOUD WASTE FACRRYIVEHICLE <br /> 14�)OTHIER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY 13 WASTE TIRE <br /> UNnEROROUNO TANK(MONRORINOIREMOVAL) ❑DOG KENNEL P DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑WASTEwATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY O MOTEUHOTEL ❑PUMPER TRUOKIYARDICIIEm TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIrY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAIueLE FOR REVIEW. MONDAY-FRIDAY H:00 AM 6:0OPN - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address <br /> indicated abovQ, 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 he 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 /> EHe 48424W <br /> 11f2fID4 <br />