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02/13/2006 10:32 FAX 11002/002 <br /> • EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor,Stockton,CA 95202-2708 t <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.Sj90v.Or8Jehd 1 7 <br /> pp . ������,, <br /> PUBLIC RECORDS RELEASE APPLICATION�� <br /> APPLICANT: I AfA4C-L- I1 , BUSINESSIAGENCY:ADDRESS:: 2— <br /> Z��pS pC Mia TI F- ST clrr .STdak "Co/�_sraTE_p- ��_ <br /> PHONE(l): 21211— r�fG I r PHONE(2): FACSIMIL � <br /> F-_71P <br /> TENTATIVE`APPOINTMENT DATE., �D _Time: <br /> (Please allow To business days from data of application wbmltial-'Tenraff"only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQt1,�5T- 93.00 FE,(=(CAS O,t1 R CHECK ONL'n-REQUEST PROCESSED IN S BUSINE:S DAYS <br /> SIGNATURE OF APPLICANT : ![/1Ai�4fl/� DATE <br /> Electronic p Llct ❑ Map-Description <br /> Information <br /> FILE ADDRESS EHD USE ONLY <br /> streets Street Name Cny -�1(✓^F� 1 <br /> ❑ Unit 1 <br /> 2 Unit 2 <br /> a. � Unit3 <br /> s. <br /> s. Unit 4 <br /> e. ❑ Unit 5 <br /> 81 ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP Srt (LOP) ❑HousING AsATEYENT 0 WASTE IRE FACIUfWVEHICLE <br /> 7HERCLEANUP SrIE(NON-LOP) ElFOOD FACILITY OWAS'rE TIRE <br /> JJNDERGRouw TANK(MONITORINWREMOVAL) p OpG KENN4 RY <br /> 23 HAZARDOUS WASTE GENERATOR 0C1KKEN RAN" �ASTPNATERTREATMENTLoCAL <br /> ❑TIERED PERMITTED FACIUTY ❑MOTELIHOTEL ❑PUMPER TRi1CIifYPNDIQ¢IVeAL TOILETS <br /> O TATTOOMODY PIERCING 0 POOLISPA d LAND USE APnKATION Srr" <br /> ❑ MEDICAL WASTE FAcIu Y ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPHC PERMIT RECORDS ARE AVAYABLE FOR REVIEW.MONDAY-FRIDAY 0:00 AMS:00FM - ExCLUDING HOUDAYB. <br /> 1. List up to ten addresses In the space above. Select the types) <br /> of files from the list above by chectang the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091484-0138 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 avallable for review. A now <br /> application may be submitted when the flle 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 /> END aea, <br /> lw i1n <br />