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06/15/2007 09:13 4157774874 AGS INC <br /> _ PAGE 01/01 <br /> L7 �� I n i <br /> DATE R�C�IGE�D�" �' EWD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 5 2007 ENVIRONMENTA.L HEALTH DuPARTMENT <br /> ENVIF30NMEV IfALI-H 600 E. Main.Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: wwwsjgov.o41ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: A 11-,S _—[ <br /> ADDRESS: � � ,s�. p <br /> PHONE(1): s PHONE(2). FACSIMILE: <br /> TENTATIVE*APPOINTMEN DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tontst/vo only-mu d) <br /> �CHECK BOX TO EXPEDITE REQ5,O <br /> E(CASH OR CHECK ONLY)-REQUEST INESS DAYS <br /> SIGNATURE OF APPLICANT 71� <br /> Electronic Information: ❑ List Map—Description: (� <br /> FILE ADDRESS ��- EHD USE ONLY <br /> Street 9 Street Name City ❑ Unit 1 <br /> - - — -— <br /> _�.�_ <br /> 2• 3 1 ( l�0 5 r E R Vic( 1 tt unit z <br /> 3. <br /> r= I <br /> Unit <br /> nit 4 <br /> 6. C <br /> 7. ' 3 2 -� f ❑ Unit 5 <br /> W j..II;% r n r �-�• ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From t0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT I-1 SOLID WASTE FACILITYIVEHICLE <br /> IK OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY d WASTE TIRE <br /> IIK UNDERGROUND TANK(MONITORING/RFMOVAL) M DOG KENNEL ❑DAIRY <br /> X HAZARDOUS WASTE GENFRATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> iit TIERED PERMITTED FACILITY ❑MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> y0 TATTOO/BODY PIERCING ©POOLfSPA d LAND USE APPLICATION SITES <br /> W MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY)_ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AvA1LAOLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00pM - EXCLUDING 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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> days aftor receipt of application. the files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> 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 applicant. <br /> Future file reviews by the same Applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> E140411-115!711-,wour;wao <br />