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0 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON-LOP) <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />TIERED PERMITTED FACILITY <br />TATTOO/BODY PIERCING <br />MEDICAL WASTE FACILITY <br />0 FOOD FACILITY <br />0 DOG KENNEL <br />0 CHICKEN RANCH <br />0 MOTEL/HOTEL <br />0 POOL/SPA <br />0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 Am-5:00Pm - EXCLUDING HOLIDAYS. <br />0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE <br />01 WASTE TIRE <br />01 DAIRY <br />0 WASTEWATER TREATMENT PLANT <br />0 PUMPER TRUCK/YARD/CHEM TOILETS <br />0 LAND USE APPLICATION SITES <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, 3 rd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orgiehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: RaC4 -f 7174- a /4)7 <br />ADDRESS: g -3;2- /j i& .„07.. <br />PHONE (1): 1-6.'cr ‘71-6, 7 - (en..)6 PHONE (2): <br />TENTATIVE* APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) <br />0 CHECK BOX TO EXPEDITE REQUEST - $ .00 FEE (CASH OR HECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />UNIT DISTRIBUTION _ 0 Unit 1 0 Unit 2 0 Unit 3 0 Unit 4 0 Unit 5 0 Unit 6 0 Other (electronic/lists/maps) <br /> <br />FILE ADDRESS <br />EHD USE ONLY Street # Street Name City . g 61., VC /26,e &.) Ak/,-,y, a pr-mA1,0. <br /> —% Aft?-44`..•(-;7-z-tri_sf:_ Lt.7,1 II I -d- 1 0 '7,1 t--e— I,— 6. <br />• <br /> <br /> <br /> <br /> <br />ate Range of Information Requested: From c to r , p <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />EHD LOG NUMBER <br /> <br />FACSIMILE: <br /> <br />DATE <br />BUSINESS/AGENCY: 4/6 '',/c1 /11 <br />List up to ten 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 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 />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 />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 />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 />END 48-02-006 <br />1/14/05