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OCT-21-200e 10:37A FROM:GEOPHAA ENV 2095690295 4640138 P.2 <br /> 1-,IST FiEt 1if VIT' 'S;',8; EHD LOG NUMBER <br /> Ll <br /> SAN JOAQUIN COUNTY <br /> 'I Z 0 01 8 <br /> ENVIRONMENTAL HEALTH DEPARTMENT 000% <br /> 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 dC, if Oak <br /> Telehone: (209)468-3420 F (209)464013 8 We : wwwsjgov.org/e <br /> Aft <br /> 1== `y°;'-,,"!'� t_iv I T. pax: - <br /> v.Z�e <br /> A <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Q r BUSINESSIAGENCY: 6;oo se 4-1 <br /> ADDRESS:,2-5?37 <br /> PHONE(t): PHONE(2): FACSIMILE, <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*TentaUve only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQUESX.95.00 FEE(C SH OR CHECK ONLY)j1EQUEST PROCESSED IN SUS NESS DAY,'--*.g <br /> 4:�" <br /> SIG XATCRE OF APPLICANT DATE <br /> Electronic Information: (] List[I Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street III Street Name City ❑ Unit i <br /> 2. ❑ Unit 2 <br /> 3. <br /> 4. <br /> 5. <br /> Allow- Unit 4 <br /> 6. <br /> 7. 1111111I.-Y Apow 0 Unit 5 <br /> 8- <br /> 9. El Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �DERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLEER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY 13 WASTE TIRE <br /> NO <br /> NDERGROUND TANK(MONITORINGIREMOVAL) M Doo KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR D< M CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL El PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BOGY PIERCING 171 POOUSPA D lek <br /> I?LAI,� ,,E APPLICATJON SITES <br /> 13 MEDICAL WASTE FACILITY /eOTHER(PLEASE SPECIFY)) ly 'Wjl '0111 lot Z�!I-Ir <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Am-5:00pm - EXCLUDING HOLIDAYS. <br /> 1. List up to ton addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file typo MUST be selected. Fax to(209)464-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ton(10) <br /> days after receipt of application. The files will behold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A filet that Is actively being worked on by EHD staff may not be Immodiatoly available for review. A now application may be <br /> 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 applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> 10- A;-0k 55146 142Z-ot. "Q'i d ea u)" k-cao -C-59(p <br /> EHD 48-06 9113/2006 <br />