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02/24/2002 07:03 209467111f AGE STOCKTON PAGE 01/01 <br /> AMM'Wo <br /> SAN JOAQLT�N COiJNTX EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTii DEPARTMENT <br /> JUL 1 3 2006 304 Fast Weber Avenue, 3'd Floor, Stockton, CA 95207-2708 q55 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: G•I aoAGENCY: <br /> SINES <br /> ADDRESS: p <br /> � GZ� C v <br /> PHONE(1); t4,LJJ <br /> 2 l45n b PHONE(2): _ FACSIMILE: f (' <br /> TENTATIVE"APPOINTMENT DATE: _Time: <br /> (Please allow 10 hwalness days from date of application submittal-"renfaf/ve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93 00 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS 0,s <br /> SIGNATURE OF APPLICANT DATE <br /> =/2-(- <br /> 0 <br /> UNIT OISTRIBUTION ❑ Unit 1 ❑Unit 2 ❑Unit 3 ❑Unit 4 ❑UMt 5 ❑ Unit 6 ❑ Other(electronlc/Ilsts/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> $treAt#� Street Name City. <br /> 1. <br /> 2 ' <br /> 4. !), <br /> 6. <br /> 7 <br /> 8 <br /> 9. <br /> 10. <br /> Specific Date Range of Infor nation Requested:From F7 to 200 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES £ �f1 <br /> UERGROUND TANK(UST)CLEANUP L P IM HOUSING ABATEMENT 13 SOLID WASTE FACILITYNEHICLE <br /> G NDER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGMEMOVAL) ❑DOO KENNEL ❑DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMrrrEO FACILITY ❑MOT£L/HOTEL ❑PUMPER TRUCK/YARD(CHEM TOILETS <br /> fa TATTOo/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 4 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE POR R£Vi£W- MONOAY-FRIDAY 8:00 AIA-6:00PM - EXCLUDING HOLIDAYS. <br /> 1. 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. x 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 /> 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 END 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 /> EHD as-0�-0vs <br /> 1114109 <br />