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� s <br /> 03/10/2005 15:44 FAX 510 420 9170 ^ CAMBRIA 0001 <br /> HEO <br /> R owlEHDLOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR1 0 2005 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> ENS (� E�jjEjkU telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 04rmA C FLAK BUSINESS/AGENCY: <br /> ADDRESS: 6;906 (Ac►.c...S S i s�.t A, <br /> PHONE(1):�Sly� 4A0- 33lnU -PHONE(2): �s-200 FACSIMILE:CSYO) N.tb-9/7[1 <br /> TENTATIVE"APPOINTMENT DATE:_�rti3 A� Time: L�ty AM <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ,3- io-&-C- <br /> UNIT DISTRIBUTION ❑ Unit T C7 Unit 2 Unit 3 Unit 4 Unit 5 ❑ Unit fi ❑ Other(electroniGllsts/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> 1. 56 o <br /> I if <br /> _ - ;.Coll <br /> 4. <br /> 6. A& <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of InfonMation Requested:From f QQn to <br /> �r//// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> QTHER CLEANUP SITE(NON-LOP) 0 FOon FACILITY ❑WASTE TIRE <br /> rPNOERCROUND TANK(MONIrORING/REMOVAL) 0 DOG KENNEL E3DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 0 POOL/SPA ❑LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - 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 least one file type MUST be selected. Fax to(209)464-0138 or mall to the address <br /> indicated above. Afa6i-,.s wl rlvi be accepted-for additional asbistance 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 she7,rild 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 /> EHo4a-02-006 <br /> 1114105 <br />