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May. 18. 2000 9. 52PM 4dvaneed GeoErvironmental No. 4936 '. 2 DATE RECEIVED EHD LOG NUf:18ER "'E"(��E c V[E'[�;D SAN JoAQCJIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 MAY u L�d6 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd ENVIRO%IEN I HEALTH PUBLIC RECORDS RELEASE APPLICATION Pf l' 1 �acrrss�am r APPLICANT: U l'1 M BUSINESSIAGENCY; a r�� ADDRESS: b Q 6 S �yCY r)T-10 10 q.a� e // PHONE(i): r7�QJ' 1 ! T�DC.�[P PHONE(2): d,��D,��7.. --" [/V ' �aA~I FACSIMILE: D 7 ' 71 `t_�a' TENTATIVE*APPOINTMENT DATE: a q Maq &o Time: /0:0,0 A0, . (Pleas.allow 10 business days from date of applka,Ion Submittal-"Tentative only-must be contlrmed) CHECK BOX TO EXPEDITE E T-$93.00 FEE(CA CHEACK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE UNIT DISTRIS JTION ❑ Unit 1 If Unit 2 0 Unit 3 ❑ Unit 4 ❑ Unit S Q Unit B M Other(electronlclllstslmaps) MYM�!•N FILE ADDRESS EHD USE ONLY Str..t>i Street Name Ctty 2. PS-K HIMWaVst:: 3. f 0 It 4. j t e`S ,4C Y y.. . 5. u e r, M(- , 6. /l / C e. N ttrn t 9. 10. � _ Specific Date Range of lnformatlon Requested: From to _ ENVIRONMENTAL HEALTH DEPARTMENT FILES sUNDERGROUN7 TANK(UST)CLEANUP SITE(LOP) In HOUSING ABATEMENT ❑SOLID WA&TF FACILITYA EHICLE 'OTHER CLEANUP SITE(NON-LOP) EI FOOD FACILITY ❑WA.o,TE TIRE ,UNDERGROUNJ TANK(MONITORING1REToovAL) ❑DOG KENNEL ❑ DAIRY „H.A7.ARDOUS YIASTE GENERATOR ❑CHICKEN RANCH IDWASTEVVATER TREATMENT PLANT G TIERED PERMITTED FACILITY ❑MOTELJHOTEL ❑ PUMPER TRUCPJYARD/CHEM TOILETS C TATTOO/BODY PIC_RCING ❑ POOIJSPA �I LAND USE APPLICATION SITES ❑MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) / WELL AND SEPTIC PERN11T RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5;QOPM - EY,CLUDING HOLIDA'Y$. 1. Llst up to teen addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to 209)464-0138 or mail to the address Indicated above. Address ranges will not be accepted-for additional assistance with file addresses, co-itact the EHD.Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD fifes exist. An appointment for review wili be confirmed approxirnately ten(10)days.after receipt of application. The files will be held for a maxirnuln of live buscr.¢mss days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A. new application may be submitted when the file is available. 4. Any file not returned In the same condition as released will be reorganized by EHD stzff at the expsnae 0� the applicant. f=uture file reviews by the same applicant may require a$93.00 deposit prior to review. EHD OA-02.ON 1!14(05