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Jul. 13. 2000' 2:53PM A Iced GeoErvi ronmental No, 5480. 1 <br /> DATE =HD ��UU�ER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor., Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.,,jgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT- 1. y�° 11 6o ,, f/ BUSINESS/AGENCY: c <br /> ADDRESS: S =�7`_1 8 a J C-W- /moi�) q 1�J ! <br /> PHONE(1): a 6 - 1 (f7 ! _r 40& PHONE(2): '/ 1 - //-- "! 2f FACSIMILE: �D <br /> TENTATIVE*APPOINTMENT DATE: 19 jo 1y p?©Q& fwd Time: /6-0-0 Q r"' <br /> (Please allow 10 busing"days from date of application submittal•'Tentative only-must be confirmed) [J: ,r^ a� <br /> ly CHECK EOX TO EXPEDITE R EbT-;93.00 FEE(C OR C ECK ONLY)-REQUEST PROCESSED IN 3 B SINES'"DAYS <br /> SIGP �TLIRE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 d Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 M Other(electroniellistslmaps) <br /> FILE ADDRESS EHD US QNLY <br /> Street#` Sheet Name Ci <br /> �. G►A [t <br /> 4. ;ra <br /> 6. = e " o <br /> 6. S u _ <br /> 7. _ rrar>`T` 'rpt? C <br /> 8. CI-t tri Rl ObK <br /> LILML_�o ve t <br /> )J!'s-F+ecitic Date Range of information Requested: From to / <br /> nf_s.'"CE' OnLLA — ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOF) ❑ HOVSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANL P SITE(NON-LOP) ❑ FOOD FACILITY ❑Wt—P-,E TIRE <br /> NDERGROUND TANK(MONITORINGlRErAOVAL) Q DOG KENNEL DAIRY <br /> ` HAzAPDOUs WASTE GENERATOR ❑CHECKEN RANCH ❑W;V7EWATER TREATR1CN'r PLANT <br /> C7 TIERED PERMITTED FACILITY ID MOTELp(HOTEL Q PUYPER TRUGWYARDICHEM TOILETS <br /> C1TAT1'00113ODY PIERCING 11POOUVPA L_&Nr,US'-APPLICATION SITE$ <br /> ❑ MEDICAL WASTE FAI:iLITY D OTHER(PLEASE SPECIFY) <br /> WELL hHO SEPTIC PERMET RECORDS ARE AVAILAELF FOR REVIEW- MONDAY-FRIDAY 8.00 AM-5:00pm - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In they 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(2091464-0138 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 recelyed 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 V411 be confirmed <br /> approximately ten (10) nays nfter 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 EH®staff may not be immediately available for review. A neva <br /> application'lhay be submitted when the file is available. <br /> 4. Piny file not returned in the sante condition as released will be reorganized by EHD staff at the expense of bie <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> I <br /> EHD 4872.008 <br /> 111M04 <br />