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00/27/2006 10:53 FAX 1)002 <br /> DATE RECEIVED EHD We IJUMBcR <br /> SAN JOAQUIN COUNTY <br /> ENVTROIaTMENTAL HEALTH DEPARTmENr <br /> 304 East Weber Avenue,P Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468 3420 Fax,(209)454-0138 Web:w-ww.sjgov.or&/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: G &06u. BUSiNESSIAGENCY:.1A — <br /> ADDRESS: -14 bl9KC—l" _!2 L2 Pl_P11 ( ®C AS 01: !g51-m <br /> PHONE(1): PHONE(z): FACSuttILE: 2A ."' Z. <br /> TEidTATIVE*APPOINTNUIT DATE: Time: <br /> (Ple-wo allow 10 buslnoss days from dam of application submittal-'Tentativ'e only-must be C*nfimtad) <br /> ® CHECK BOX TO EXPEDITE R U -$93.00 F (C HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE i D <br /> UNIT DISTRIBUTION d Unit Unit ❑Unit 3 E3 Unit 4 13 Unk S ® Unit 6 13 Other(clac rorildiis�lmapg) <br /> FILE ADDRESS _._ EHD USE ONLY <br /> Street i_ Strom Name EA-Y <br /> � ;�2.v Z> l�k�'tM�1�,_LTJ. . .._ ._. _ _ �'►��cd�3=lptit . ..____. <br /> - .1 1-Yo 4 <br /> s: <br /> 7. a <br /> 0 _ <br /> 10. i <br /> Specific Date Range of Information Requested.From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP Slim(LOP) ❑HOUSMG ABATEMENT ©SOLID WASTE FAC1uTYIVENCLE <br /> OTTER CLEANUP S TE(NDN-LOP) ❑FOOD FACILITY WAM TIRE <br /> UWERGMMD TANK(MOMTOmNWREmOvAL) Q Doe Kboam 17 DAnty <br /> HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑wASTI:wATER TRzATmEw PLANT <br /> ❑TIERED PERNnTED FACILITY E3 MO'IELIHOTEL ❑PULER TR=rjYAr4M0HEM TOILE'T'S <br /> Q TATTOMODY PILING C!POOL/SPA 13 LAND USE APPucxnoN SITES <br /> Cl MEDICAL WASTE FAcv Ti r 13 OTHER(pLEmE SPE{XFYI <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MoNbAY-FRIDAY&00 Ada-5:00PM - EXCL uyING Ho+L tram <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0735 or ntall 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 flies 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$83.00 deposit prior to review. <br /> 1 I <br /> ;T:7- <br /> t .5 <br /> EW 494n4M , <br /> 1N4f08 <br />