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BATE --_ — ...�� 710 aoc O.Lvju r.bli01 <br /> SAN JOAQUIN COUNTY v.... <br /> ENVIRQNMEN�AL 11EALTH DEPARTMENT <br /> IUN - 7 2005 304 East Web6r Avenue; Yd Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)4'G8-3420 Fax: (209)464-0138 Web: www.sjgov.org1ed <br /> EWRaNRENT HEALTH '� <br /> :PER."TISFRVIC PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: inr4il !I BUSINESS/AGENCY.- <br /> ADDRESS; <br /> USINESS/AGENCY:ADDRESS: 11 ISQgMEP <br /> — <br /> PHONE(1): _, G,RSfs,"2'5 �{ RM ONE12}: —��e`.,.. -&& _FACSIMILE:glib 11(aa RIQQ <br /> TENTATIVE*APPOINTMENT DATE: 40 1 Time: <br /> (Please allow 10 business daysIca <br /> from data of application submittal-*Tenmdve only-must be confirmed) <br /> CHECK SOX TO EXPEDITE REQUEST-1$93.00 FEE'l(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> II <br /> SIGNATURE OF APPLICANT DATE d <br /> F F <br /> UNIT DISTRIBUTIOI4 Unit 1 ❑ Unity 2 Unit 3 Unit 4 Unit 3 Unit G ' 0 Other lelearonimistelmaps) <br /> FILE ADDRESS <br /> reet# Street Name!l 7 City EHD USE ONLY <br /> St <br /> 1. <br /> 2. ill N _ I <br /> F7. <br /> Specific Gate Range Of Information Requested; From to _ J <br /> E ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Iia UNOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 114 SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑Fo6o FACILITY 1%WASTE TIRE <br /> `U„QE"GROUNDTANK(MONITGRIN0REMOVAL) 0 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR n CHICKEN RANCH M WASTEWATER TREATMENT PLANT <br /> TIERE13 PFRMIYTED FACILITY 0 MOTEUHOTEL 0 PUMPER SRUCKIYARDICHEM TOII.eTs <br /> ❑TATTOO/BODY PfERCING ©POOL/SPA ❑LANO UsE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITYw 13 OTHER(PLEASE SpECIKY) <br /> WELL AND SEPTIC PI:RIaR RECORDS ARE AVAILA6LE FOR REYIEw - MONDAY-FRIDAY 8:00 AM-S:OOPIy EXCLUDING HOLIUATS, I <br /> 1. List up to ten addresses in the space above, Select the type($)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 abovs. Address ranges wlillinot 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 appilcation. 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 ley EI4D 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 l:y the same applicant may require a$93.00 deposit prior to review, <br /> M4lp6.OY-006 � i <br /> iF <br /> TOTAL P.01 <br />