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May. 18. 2006 9:52PM Advanced GeoEnvironmental No. 4936 '. 2 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD 1,0G0G Nl1t:-18EC� <br /> U <br /> 15I�^U ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1l 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> SAY v L0�6 Telephone: (209)468-3420 Fax- (209)464-0138 Web:www.sjgov.org/ehdZ3 "7 I <br /> ENVIRC(d(�fiEN l- HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:� U h 6 1 <br /> BUSINESSIAGENCY; JC <br /> ADDRESS: bQ S-t-0 ck ' <br /> PHONE(1): Q©& PHONE(2): �OT - y1d " � / rFACSIM(LE: D p- V_?Q <br /> r `tYu <br /> TENTATIVE*APPOINTMENT DATE: _2!/ &ft &') U <br /> Time: 10:00 � <br /> (Please allow 10 business days from date ola,,Ikalion submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE E T-$83.00 FEE(CA CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ �� DATE <br /> UNIT DISTRIBUTION ❑ Unit 1 If Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit s ID Unit B ❑ Other(electronleflistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> $treat t� Street Name city <br /> A <br /> 3. ! 0 tr 1 er <br /> 4. v �S <br /> 5. u e_ <br /> 6. IJAVVL <br /> chi all —' <br /> 9, <br /> 10. <br /> Specific Date Range of.lnformatfon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> sUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILnYNEHICLE <br /> BATHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WAS TE TIRE <br /> UNDERGROUND TANK(MONITORINCdREMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> „HAZ..ARDOUS Y'IA:'TE GENERATOR ❑CHICKEN RANCH ❑WA.STE\NATER'+RE9ATMENT PLANT <br /> G TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEPA TOILETS <br /> ❑TATTOOIBOIDY PIrRCING C1 POOL/SPA GLAND USE APPLICATION SITES <br /> G MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 APA-5;QOPhl - EXCLVDmu HOLIDAY$. <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. Fax to(209)464-0138 or mail to the addre, <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addresses, coatac<: <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 fifes exist. An appointment for review wili be confirmed <br /> approximately ten(10)daye•after receipt of application. The files will be held for a maximum of five bus!r M-3 <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that if;actively being worked on by EHD staff may not be immediately available for review. A. now <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 exp?nae of the <br /> applicant. f=uture file reviews by the same applicant may require a$93.00 deposit prier to review. <br /> EHD 4nA2.008 <br /> 7!14(05 <br />