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Jul. 13. 2006 2.53PM A0ced GeoEnvi ronmental No. 5480. �. 1 <br />DATE ktUtIVtU SAN JOAQiJIN COUNTY cHD ,vU11SEF2 <br />ENVIRONMENTAL HEALTH DEP.AARTMENT*_." <br />304 East Weber Avenue, 3rdFloor; Stockton*, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sj#�ov.org/ehd 7PUBLIC RECO S RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: <br />BUSINESSIAG ENCY: <br />PHONE (1): ' Y (17 7 PHONE (z):s7( U`f " "!/d " tA V / W FACSIMILE: &KU ( " %L� I " I I 1 S r <br />TENTATIVE* APPOINTMENT DATE: 17 0 Lh O( 010 C� � Titre; �+ 0 6 r' &r 11f r <br />(Please allow 10 businass days from date of application mbin"Ittal - °Tent&HA only, must be confirmed) ( re- Zk J <br />CHECK BOX TO EXPEDITER E, T - S93.OQ FEE ( OR G ECK ONLY) - REQUEST PROCESSED INZ&,3 <br />3 ® INES- DAYS <br />SIG iTURE OF APPLICANT DATE� <br />UNIT DISTRIBUTION It <br />Unit 7 tfUnIt 2 13 Unit 3 ❑ Unit 4 ❑ Unit 5 ® Unit 6 ❑ Other (®Iectrcnlclilstslmag ) <br />FILE ADDRESS EHD USI ONLY <br />Stmt Street Name I Cit}( I----. . <br />0 <br />M, <br />.-�Speclfic Date Range of Information Raqvesled: <br />ROFrom <br />DEPARTMENT <br />UNDERGROUND TANK (UST) CLEANUP SITE (LQF) E3 HOUSING ABATEMENT 13 SOLID WASTE FACILITYIYEHICLE <br />OTHER CLEANUP SrrE (Nos -LOP) ❑ FOOD FACILITY ® WmTe TIRE <br />NDERGROUND TANK (MONiTORiNWRFMOVAL) A DOG KENNEL M DAIRY <br />HA2ARbOUS WASTIE OUNERATOR ❑ CHICKEN RANCH 0 WA$ MWATER TREAwENT PLANT <br />* TIERED FmMTTTED FA01UTY © MOTELMOTEL Q PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOOISODY PIERCING 17 POOLISPA VLAND Uer; APPLICATION SITES <br />ID MEDICAL WASTE FACILITY 13 OTHER (PLEASE CaPECIFY) <br />WELL AND S£P nc PERMIT R=RDs ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 0.00 AM-5;QQPM - EXCLUDING HOLIDAYS. <br />1. List up to ten addresses In the space above. Select the type(s) of fifes 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 �daay be submitted when the file is available. <br />4. Any file not returned in the sante 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 />EID 48.92.006 <br />1/140 4 <br />