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11/02/2005 15:56 7077 71 CERES ASSOCIATE PAGE 01/01 <br /> 40 <br /> L <br /> EHO Lc)G NUMBER <br /> DATE RECEIVED .. <br /> J, <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3d Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.,%j9Ov,0T9/ebd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ITY W"\. /-key 4-(- BUSINESS/AGENCY: <br /> ADDRESS: C'J.", <br /> PHONE(1): -7c,-7 1-(CO-3170 PHONE(2): S 30 3-DO ------ __FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 0 business days from date of npplIcAtlon submittal-*Tentative only-must ba confirmed) <br /> CHECK BOX TO EXPEDITE REQUE ^$93.N FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 17,psI-- - - DATE IP1311r'5 <br /> 09- <br /> UNIT DISTRIBUTION C3 Unit I ZUn N 2 &C Unit UnIt 4 0 it 5jWUnIt 6 Other(elOctrOnIcAlsts/MaPS) <br /> FILE ADDRESS EHD USE ONLY <br /> -Street 9 Street Nam City <br /> 2. <br /> 4. <br /> 6. <br /> 7. �2 <br /> s. <br /> 91 <br /> 110. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> RONOERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEmEw *OUD WASTE FACILITY(VEKlCLE <br /> KbTmER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY &XASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORINGMEMOVAL) 11 Dor,KENNEL C3 DAIRY <br /> DOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> —§*TIERED PERMITTED FACILITY 0 MOTELIHOTEL 13 PUMPER TRuc KtYARDICHEm ToLrTs <br /> C3 TATTOOMODY PIERCING 0 POOLISPA P<LAND USE APPLICATION SITES C003 <br /> 13 MEDICAL WASTE FAciLiTy C3 OTHER(PLEASE SPECIFY) 7C= <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RmFw- MONDAY-FRIDAY 8:00 AM-5:00PM - ExCLuDFNr.HOLIDAYS. <br /> 1. List up to ton addresses in the space above. Select the type(s)of files 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 mall to the address AMC <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 flies exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The flies will be hold for B 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 /> 11 M 'vi <br /> 4. 67 <br /> fm'100­k-�&o V) d <br /> y <br /> L <br /> EHD 4042-NO <br /> 1114M5 <br />