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MAR-11-2005 03:56 FROM: <br /> 919252948687 94640138 P.1/1 <br /> sogj <br /> C�-� <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �}� 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> "ENS elephonc:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 571 <br /> Et�PukgIT '�ERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: A�` /J� BUSINESS/AGENCY: <br /> ADDRESS: )) I OZ-! ALO/ T e�tcC Cir ti J r <br /> CL <br /> PHONE(1 •meq✓ b�' 'Z I PHONE(2�t) �g - �� FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: 4fko 7 Time: <br /> (Please allow 10 business days from date of applicatlon submittal-•Tontat/ve only-must bo 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 <br /> UNIT DISTRIBUTION ❑ Unit 1 Unit 2 nit 3 nit 4 ❑Unit 6 0 Unit 6 ❑ Othor(olectronle/ilsts/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street* Stroot Name city <br /> 01-i Am <br /> 2. <br /> 3. �� <br /> 4. �j <br /> 5. <br /> 6. <br /> 7. _ <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHtCLE <br /> "EI OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH -'-C WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY a MOTEUHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATroomODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> 11 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-S:OOPM - EXCLUDING HOLIDAYS. <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 /> 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 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 /> EHD IE-02-006 <br /> vwoa <br />