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Jan 29 U( 1U,11a Apex 20S 37-9668 PJ <br /> EHO LOG NUMBER <br /> SAN JOAQMN COUN_ <br /> .IAN 2 9.2007 ENVIRONMENTALREALTH DEPARTMENT <br /> ENVIRONMENT HEALTH 304 East Weber Avenue;3`l Floor, Stmkton, CA 95202-2708 <br /> VIPERMLAMENT HEAL Telephone: (209)468-34-20 Fax:(209)464-0138 Web: www.sjgov.org/elid <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: .. Q('ew Ay, Alul^ .. 13UIMNESSIAGENCY: ./ o ev_ <br /> ADDRESS: 3`44C- 0+ &--,0-UA Sf,,-k FILOJ_S---O-c L rQu b-zCKG4 g576-L <br /> PRONE(I)* Z'�rf fo�•'F - CaR3�") PHONE(2): ZCt Cd�`�— Z�-SZ _-FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: � �Z" 3-T Tlme: d! � <br /> (Please allow i0 business days from data of application submittal '7enfauve only-must be confirmed) <br /> C1 CHECK BOX TO EXPEDITE RET .00 EST-$93FEE(CASH OR CHECK ONLY)=REQUEST PROCESSED IN 3 BUST ESS DAYS <br /> SIGNATURE OF APPLICANT f11�'Ivl\\ DAT f 1Lco <br /> UNIT DiSTRIBUTIDN d Unle 1 O Unit 2 0 Unit 3 . ❑Unit 4 ❑ Unit 5 CI Unit s 17 Other(aleelronielilstshnaps) <br /> FILE ADDRESS EHD USE ONLY <br /> P0. <br /> eet# Street Name city _ <br /> 55 ]`!. <br /> 5G <br /> Specific Date Range of Information Requested:From Z `�y to <br /> � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �, <br /> .�.UNDERGRDUNo TANK(UST)CLEANUP SfTE(LOPI CI HousiNa ABATEMENT C3 SOUL)WASTE FACILITYNEHICLE <br /> C]OTHER CLEANUP Sim(NC3 F <br /> ON-LOP) ogp.FAcIuTY la wAsTE TIRr <br /> 13 1,fNOERGRouNO-rANK(MONITOmNG1REMOVAL) ❑Dor.KENNET, DAIRY <br /> E3 ifAZ41100U5 WASTE GENER <br /> A <br /> TOR 0 CHICKEN RANCH E3 WASTEWATER TREATMENT PLANT <br /> CI TIERED PERIAMIED FACILITY Q MOTE1HOTF]_ I7 PUMPER TRUC"ARDICHEM TOILETS <br /> 0 TATTOWBODY Pia:KING E3 POOLISPA C3 LAND USEAPPL1cAmm SITES <br /> NtEDICALWASTEFACILITY Q OTHER(PLEAWSPEC <br /> K <br /> WELLAND SEPTIC PERM[Y REcDRm ARE AVALLASLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:0oPN - EXCLUDING HOLIDAYS. <br /> I. 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[east one file type MUST be selected. Fax to 209 4640938 or mail.to the address. <br /> indicated above.I 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 f6r review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will he held for a maximam of five business <br /> days for review. Appointments should be scheduled accordingly: <br /> r 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A now <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 /> EH D 1642-006 <br />