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Ubl 15/:ZUU t 14: 53 <br />In] <br />r ! I 1 5 2007 <br />ENVIN NIENT HEALTH <br />PEP, INI1T/SERVICES <br />APPLICANT: ;2l_7_ <br />ADDRESS: �?2S5 <br />2133800505 <br />ENVIRONMENTAL <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMEN <br />304 East Weber Avenue, P Floor, Stockton, CA 9520 - 8 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sj v. ro <br />PUBLIC RECORDS RELEASE A.PPLICA ON <br />PAGE 01/01 <br />EHD LOO NUMBER <br />- <br />PHONE (1): OaS PHONE (2): FACSIMILE; <br />TENTATIVE' APPOINTMENT DATE: �... Time: _ <br />(Please allow 10 business days from date of application submittal - *Tenradve only - must be <br />Z <br />❑ CHECK BOX TO EXPEDITE REQUEST. . 0 SH p K ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT I — DATE <br />Electronic Information: ❑ List ❑ Map – Descriptlon. <br />FILE ADDRESS <br />EMD USE ONLY <br />Street# <br />Street Name <br />City <br />s ,��,. /� ❑ Unit <br />utS-T(c I " <br />'F2.1 <br />ZS <br />Caw.-rr C r�4�_ <br />27 r0 <br />�. <br />� ❑ unit z <br />3. <br />4. <br />Unit 3 <br />5. <br />Unit 4 <br />6. <br />7. <br />❑ Unit 5 <br />$ <br />L. <br />1:1Unit 6 <br />10. <br />Specific Date Range of Information Requested: From <br />to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />`•UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE <br />_� <br />�❑y O.�THER CLEANUP SITE (NON -LOP) El FOOD FACILITY 0 WASTE TIRE <br />,-J:2: 1NDERGROUND TANK (MONITORINGIREMOVAL) El DOG KENNEL ❑ DAIRY <br />tA%IAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL C7 PUMPER TRUCKIYARDICHEM TOILETS <br />M TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />13 MEDICAL WASTE FACILITY 13 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILARLE FOR REVIEW - MONDAY -FRIDAY 5!00 AM-O;OOPM - EXCLUDING HOLIDAYS. <br />1_ List up to Eon 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 type MUST be selected. Fax to (2091464-0138 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 flies exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt Of application. The files will be held for a maximum of five business days for review. Appointments <br />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 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 />ENO tB..6B 9f'13YlOOfl <br />EHD USE ONLY <br />