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Ju I. 13. 2006 2:53PM Adv��ced GeoErvironmental No. 5460. p. 1 <br /> DATE ktCtlVhD �HU L ,,.UI,,-4ER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT _ <br /> 304 East Weber Avenue, 3r6 Floor; Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION "� /J <br /> APPLICANT: It n do BUSINESSIAGEOA (N�CY: v V%(R <br /> ADDRESS: <23r�j qq p i 'S /y ba STD/ya 01 S I S p / r �+� <br /> PHONE(1):�{(/ / ' 7 lk / "!(!Q� PHONE(2):n'RD 7 ' //O� tJC�-/ tf FACSIMILE: �D / " V l II/( If i <br /> TENTATIVE*APPOINTMENT DATE: I7 J0 �� 14040`& 6t)ed Time: (O� QY-'�p t'�F E�V� <br /> (Please allow 10 business days from date of application subm'dtal-'Tant&Vvb only-must be confirmed) IF= f e. o <br /> CHECK EOX TO EXPEDITE R E.ST-$93.00 FEE(C OR CVE,CK�ONLY),•REQUEST PROCESSED IN�3 B SINES^oAY I +�f �' <br /> SIG TURE OF APPLICANT (ti C.�Q L DATE / B A. <br /> =UNIT 0 Unit ttUnh2 ❑ Unit3 ❑ Unit4 ❑ UnI16 ❑ Unite ❑ Other(BisctroNdllstslmapS) <br /> FILE ADDRESS EHD U5 ONLY <br /> Streets Street Name Ci <br /> 1. oa — a <br /> z. , 1 „' ,, <br /> 3. <br /> 4. <br /> 5. B `h0 r <br /> 7. a .l C <br /> l >' <br /> >f Specific Date Rang®of Information Requested:From �fIO to <br /> I)f F-I ce– 0n41 — ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(US <br /> CLEANUP SITE(LOF) 13 HOU&ING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE <br /> DTHER CLEANUP 61 E(NON-LOP) ❑F000 FACILITY ❑Wo:TE TIRE <br /> NDERGROUND TANK(MONRORINGIREROVAL) QDOG KENNEL QDAIRY <br /> HAZAROOVe WASTE GENERATOR 13CHICKEN RANCH ❑W90FEWATER TREATMENT PLANT <br /> tl TIEREO PERMITTED FACILITY 13 MOTELIHOTEL �Q./PUVPER TRUCWYARDICHEM TOILETS <br /> ClTATTO01SODY PIERCI.NC 13POOLISPA ILMO USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FAu'iLrrY O OTHER(PLEASE SPECIFY) <br /> WELL AIIO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REYIEw , MONDAY-FRIDAY 8:00 AMS-OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addressos In the space above. Select the type($)of flies 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 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 businoss 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 Nvorked on by EHO staff may not be immediately available for review. A new <br /> application Aay 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 /> EHD 4847.,008 <br /> 1114(0 <br />