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06/26/2006 14: 11 FAX ?002/002 <br /> vA€t rcec1nIVEu *• SAN JOA UIN COUNTY •• <br /> Q <br /> jPNVIS;t3NMF.NTA1.. HEALTHUII,AftTMEN1' <br /> �, 2006 304 Last'Veber Avenue, 3'd Floor, Stockton, CA 95202-2708 <br /> jL <br /> II<I Telephone: (209)468-3420 Fax: (209)464-0138 Web: wvnvsjf,ov.orglchd <br /> ENVIROIWIEW-i HEALTH yp <br /> .Rw �..... R-V-IyCES�W...P.�U.tiR.0_I,.�.__..IC,.... RECORDS <br /> RT-E_:..LE.-A--+S-E' APPLICATION <br /> APPLICANT: EUSINESAG'NGY:.t_ADDRESS: CITY .,.S <br /> _N— <br /> STATE <br /> TATE.._.. <br /> ...�.. <br /> PHONE(1): f`'I:� ` 1 �''i J PHONE(2): ,-,— FACSIMILE:1;:%C+'"V <br /> TENTATIVE"APPOINTMENT DATE: 0 <br /> (Please allow TO business days from date of application submittal-'Tentative only-must be confinncd) <br /> 17 CHECK BOX TO EXPEOME REQUEST-$9 6E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /`_..._ �/ DATE /d(L. — — <br /> Electronic ❑ List ❑ Map-Description <br /> Information -- _ <br /> FILE ADDRESS EHD USE ONLY <br /> Sheets Street Name, city <br /> k .. <br /> , i I k �L•. t� ❑ ..,Uflit "I... . <br /> X70 ? _�6.7.L� Llc .�• _�1 <br /> 1F........ lieu 2 / <br /> ?// 3 Jill cu \(� <br /> 4 - --� — Unit 3 <br /> 5 ..._.. �........_...... <br /> - - <br /> s- — - - - <br /> 7 - <br /> 1 — <br /> 1 �A <br /> I <br /> r ' <br /> _ -- ni rJ <br /> /Unit 6 <br /> Speai is Date flange of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> j UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT .M"..SOLID WASTE F,ACILITYNEHICLE <br /> K OTHER CLEANUP SITE INON-LOP) D FOOD FAcoity d WASTE TIRE <br /> 0 UNDERGROUND TANK(MDNITORING/RF.MOVAL) O DOG KENNEL ;R DAIRY <br /> P HAZARDOUS WA3Tt GENERATOR ❑CHICKEN RANCH 9 WASTEWATER TREATMENT PLANT <br /> C+TIERED PERMIT-,CD FA,c1LRT ❑MWELAHOTEL ❑PUMPER TRUCKNA.RD(CHEMICAL TOILETS <br /> ❑TATTOO/BDoY PiERCI.NG n POOVSPA 0'LAND Use APPLICATION SITES <br /> C MEDICAL WASTE FACILITY M OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERFBT RECORDS APE AVAILABLE FOR Rav&W ,MONDAY•FRJDAY SAO AM-5:OOPM - EXCLUWNG 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. 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 /> 2. The EHD will notify the applicant if any EHD files exisL An appointment for review will be confirmed <br /> approximately ten (10)days after receipt of application. The files will be hold for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that in 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 /> 4. Any file not rotumed 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 /> I <br /> ----..---...._ ...___.._. ... .. -- <br /> _. _---� <br /> CHD ea.oe <br /> Ianeawo <br />