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U6123/2005 14:03 916-371-12119 RANEY GEOTECHNICAL PAGE 01/0 <br /> EHD LOG NUMBER <br /> DATE RECEIVED I!& <br /> SAN JOAQUIN COUNTY <br /> E ONMENT*L HEALTH DEPARTMENT �%w <br /> 304 East Weber Avenue,3rd Floor, Stockton,CSA.95202-2708 2005�- 2,3 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd P 1 i! <br /> PUBIC RECORDS RELEASE APPLICATION 141 SQe JOA oUt OOU <br /> APPLICANT: !�!! /7 _A_ BUSINESSIAGENCY: <br /> ADARESS: ��TQ '�C o7zAl' <br /> PHONE(1) ��� �7 "O PHONE(2): FACSIMI1" <br /> TENTATNE*APPOINTMENT DATE: Tune: - ..�� <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be conflnne <br /> CHECK BOX TO EXPEDITE REQUEST- BECK ONLY)-REQUEST PROCESSED IN 8 USINES DAYS ] r <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRI®UT10N Q Unit 1 nIt Unit 8 Tilt A Q Unit 5 ❑ Unit 6 ❑ Other(electroniclilstsfmaps) <br /> _ <br /> FILE ADORE EHD US <br /> \ S6reet P <br /> street Name city <br /> - <br /> T I• .. ._ �TdNr UlS � <br /> z._ C o Fpo�r s7"' �C 727 u T <br /> MeweNr sr _.. .S is � <br /> 5. <br /> Ar in <br /> s.. . EL AV <br /> Spaciffic Date Range of Information Requested;From ®._ to - t <br /> in 19 Arm <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r1jU—WqqP H <br /> UNDERGROUND TANK(USn CLEANUP WE(LOP) ❑Houma ABATEMENT ❑Smo WAM FAcitmNaHicLE <br /> OTHER CLEAntm SIVE(NO04.013) ❑FOOD PAonm ®WASTE TIRE <br /> UNDERGROUND TANK(MOMORINGIREMOVAL) E3 Do*KENNEL ❑DAIRY <br /> J14 HAunous WA=GENERATOR ❑CHICKEN RANCH )KWASTEWATER TREATMENT PLANT <br /> ❑TIEREDPEIWITTEDFACILITY ❑MOTELMWrEL 0 PUMPERTRucrtYARDICHEMT0LETS <br /> E3 TATTOOIBODY PIERCINi Q POGLISPA ❑LAND Use ApPLICATIAN SnEs <br /> C3 MEDICAL WANTS FACILITY ❑OTHER(PLEASE SPECIFY) <br /> W61.L AND SEPTA PERMIT RECORDS ARE AVAILABLE FOR RE11ON- MONDAY-FRmAr 8:00 AN-5:00m - IHCCLUDING HOLUTAYB. <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 sslected. Fax to(202)46"134m-mall to the address <br /> Indigatod 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 flies exist. An appointment Tor review will be confirmed <br /> approximately ten(10)days after receipt of application. The fifes will be held for a maximum of two business <br /> days for review. Appointments should be scheduled accortlingly. <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 retumed 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$9,3.00 deposit prior to review. <br /> END 40-N-ON ^ <br /> 1115 RUSH <br />