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06/27/2006 10:55 FAX X002 <br /> l <br /> DATE.RECEIVED EHD LAG NUMBERSANJOAQUIN COUNTY <br /> ENwRQNMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor,Stockton,CA 45202-2708 <br /> Telephone:(209)468_3420 Fax:(209)464--0138 Web:%wrw.sjeov.orr;/ehd <br /> PUBLIC RE CORDS RELEASE APPLICATION <br /> APPLICANT:_„a, ' BUSINESS(AGENCY: l�— tQR:L= <br /> ADDRESS: ,Ei,6'f_0 C.lG rte 1►,L art <br /> PHONE(1): LaPHONIE(2): FACSIMILE:. ''-!'�'�" -Z. <br /> TENTATIVE*APPOINTMENT(DATE: <br /> (Please allow 10 business days from date of application submittal-•TW900m only-must be ew inmd) <br /> ❑ <br /> CHECK BOX TO EXPEDITE R U -$93.00 F (C HECK ONLY),REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT Ac DATE 1. 1 <br /> UNiT DISTRIBUTION d Unit Una ❑Unit 3 ❑Unit 4 ❑unit a ❑ Unite ❑ Othar(siwimidilstslmaps) <br /> FiLE ADDRESS _._ EMD USE ONLY <br /> Street: �� Street Name2. <br /> 1. ------ <br /> 3. 14A�P4M0'�. � ���s•JG1=Da�1 - - <br /> t1. <br /> s. 11 .iCa- &> <br /> 7. <br /> 8. <br /> Lea <br /> 10. ( f.A1 <br /> Specific Date Ranee of Infontnation Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FiLES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LCI') C3HOUSM ABATEMENT ❑SOLID WASTE FActuTrivEmc E <br /> 91MER CLPSANUP SITE(NON-LOP) C3FOOD FAMUTY C3WAST'£111E <br /> Uwatem#MD TANK(MONITOMN0ffiEPA01(AL) 0 Dw KENNEL ElDAIRY <br /> N <br /> HAZARDOUS WASTE GENERATOR ❑anal RANCH C3 WASTEWATER TOZATMENT PLANT <br /> ❑'ruim i FERM(TTED FAcitmr ❑MOiEUHOTEL ❑P;)mrmTRUGKiYAkWHRM TOILETS <br /> ❑TA1 ooffi0oy PIERCING ❑POaA19A ❑LAND USE APPLICATION SITES <br /> n MEDICAL WAs a FA=TY ❑OrrIER(PLEASE SPECIFIC <br /> waLL AND some PERmrr RsoORDS ARE AVAILABLE FOR Rwmv- MONDAY-FRIDAY 9,00 APA-6:00FPA - M(CLUDING HOLIDAYS. <br /> I. t_ist 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(20914M&139 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 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 /> wail T��.•1 <br /> J` <br /> EHD 48-02-006 _ ,--•• <br /> 1M4.ro6 <br />