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LFR rax:5106524906 Nov 30 2n05 1631 P.01 <br /> DATE RECEIVED `fJ � SAN JOAQUTN COUNTY AHD LOG NUMBER <br /> I" ENVIRONMENTAAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> fVU 0 2005 Telepbone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> EiNVIRONNIENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> '�!�`` L.F <br /> APPLICANT: "'' NI BUSINESSIAGENCY: Kf- fnGrec R <br /> ADDRESS: 1900 owtu '5f-) j2t't4. 4I-p(K- <br /> PHONE(1): 5(a" PHONE(2): FACSIMILE: 516-16521- 4'R 06 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal•"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FE R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE i 1�;d b <br /> UNIT DISTRIBUTION O U 1 ❑ Unit 2 O Unit 3 ❑ Unit 4 0 Unit 5 ❑ Unit 6 ❑ Other(electronicAistsimaps) <br /> FILE ADDRESS EHb USE ONLY <br /> -Street# Street Name City <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> T. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From MCI O to O0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT n SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONRORINWREMOVAL) O Dob KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL 0 PUMPER TRUCK/YARD(CHEM ToILETs <br /> Cl TATTOO/BODY PIERCING ❑POOL/515A ❑ LAND USE APPLICATION SITE$ <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HoUDAYs. <br /> 1. 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 mail to the address <br /> indioted 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 EHb 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 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 /> EHD48-02.00G <br /> 1/14/x5 <br />