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11/02/2005 15:56 707741 CERES ASSOCIATE PAGE 01/01 <br /> EHD LQG NLIMaER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMXNT <br /> 304 East Weber.Avenue,3rd door, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sj9ov.0T9/ebd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: lZ�cv�. /-ke y e_r BUSINESS/AGENCY: <br /> ADDRESS: y� `� ;c<k S'�. j CM' C <br /> t� 4 <br /> PHONE(1): 70 7 1 y'0 317 0 PHONE(2): S30 3 c/ <br /> 0 300 i O� 1---- —FACSIMILE: 7� 7 7 ai g^3�'7( <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 bualneas days from date of appilca;tion submittal-"Tentative only-must be confirmed) <br /> 173 CHECK BOX TO EXPEDITE REQUE -$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 101s1 CS C <br /> As Y <br /> UNIT DISTRIBUTION O Unit 1 ZUnN Z t Unit Unit 4 ©Elt 5 &WUnft 6 Other(electronlc/llstslmaps) 404 <br /> FELE ADDRESS END USE ONLY <br /> Street M Street Name city <br /> 1. _{� Q_LO S el--i, <br /> 2. <br /> 4. <br /> 6. <br /> 7. 'I J <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From 41 �_ _____ ___ __ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NOERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT IMOUD WASTE FACILrTYIVEWCLE <br /> THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY A9TE TIRE <br /> 0 UNDERGROUND TANK(MONTTORINGIRENIOVAL) 0 DOG KENNEL ❑DAIRY <br /> DOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> IEREO PERMITTED FACILITY 0 MOTEL/HoTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOOrBODY PIERCING 0 POOLISPA LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACIL TY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERmIT REcORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:WM - 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)4640138 or mall 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 /> t-Z-SIS - Vl'1 vJ f <br /> M ` ' <br /> C I/15 <br /> - - <br /> EHD 4842408 <br /> 1M4lOS <br />