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DATyA'f1� O 11 ED -PI SAN JOAQUIN COUNTY ` <br />DARROVED <br />2 0 2006 ENVIRONMENTAL HEAI:TII DEPARTMENT <br />304 Last Weber Avenue, 3r1 Floor, Stockton SCA 95202-2708 <br />ENVIRONMENT HEALTC 0031e: (209) 468-3420 Fax: (209) 464-0138'Web: www-sjgov.org/eh <br />PERUIT1SE"CES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />EHD LOG NUMBER <br />?k48q <br />ADDRESS: -4085 ^1 u "" "' <br />PHONE(1):�15-(oG)rl- 4l/7 Y* PHONE(2): 2S•'J5FACSIMILE:��S-GOA-� �D <br />TENTATIVE" APPOINTMENT DATE: Z I D �F�DIO Time: /O /fill <br />(Please allow 10 business days from data o application submittal-`7wou" only - must be confirmed) - <br />❑ CHECK BOX TO EXPEDITE REQUEST -$95.00 FEE (CASH OR CHECK ONLY) •I REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �� A�/ afj� DATE //�3d�0___ G, <br />Electronic Information: E]List ❑ Map — Description: <br />JJ <br />,, UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />Street <br />FILE ADDRESS <br />Street Name <br />EHD USE ONLY <br />-� City ,i ❑ unit <br />UnIt22. <br />Unita <br />�Unsd 4' <br />y <br />_ ❑' Unit6 <br />❑ Unit 6 <br />0 FOOD FACILITY <br />1444 <br />TANK(MONITORINGIRrmovAL)- <br />[3.. <br />0 DAIRY <br />i�UNDERGROUND <br />,JAZARDOUS WASTE GENERATOR <br />13 CHICKEN RANCH <br />D WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />'O MOTELIHOYEL <br />0- PUMPER TRUCIWARDfCHEM TOILETS <br />y <br />0 TATTOOIBODYPIERCLNG - <br />'D POOLISPA j <br />0 LAND USE APP�ICATION SITES <br />DMEDICALWASTEFACIUYY <br />6. <br />willrlCOMitS _ <br />7� <br />9. <br />Specific Date Range of Information Requested: From ' to <br />rd 41 <br />ENVIRONMENTAL HEALTH` DEPARTMENT FILES <br />JJ <br />,, UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />Cl HOU81NGA6ArEMENT <br />O SOLID WASTE FACILITYNEHICLE <br />t,21OTHER CLEANUP SITE (NON -LOP) <br />0 FOOD FACILITY <br />0 WASTE TIRE <br />TANK(MONITORINGIRrmovAL)- <br />0 DOG KENNEL <br />0 DAIRY <br />i�UNDERGROUND <br />,JAZARDOUS WASTE GENERATOR <br />13 CHICKEN RANCH <br />D WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />'O MOTELIHOYEL <br />0- PUMPER TRUCIWARDfCHEM TOILETS <br />y <br />0 TATTOOIBODYPIERCLNG - <br />'D POOLISPA j <br />0 LAND USE APP�ICATION SITES <br />DMEDICALWASTEFACIUYY <br />02'DTHER(PLEASE SPECIFY) ;: uM�bdklq <br />willrlCOMitS _ <br />WELLAND SEPTIC PERMIT RECORDS ANE <br />1. List up to ten addresses in the space above. Select the types) of flies from the list above by checking the appropriate <br />box(es)..At least one file type MUST be selected. Fax to (209)464-0138 orlmail to the address indicated above. Address <br />ranges will not be accepted —for additional assistance with file addresses; contact the EHD. Applications recelved 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 far review will be confirmed approximately ten (10) <br />days after 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 rile reviews by the same applicant may require a $95.00 deposit prior to review. <br />Fwn IjSE ONLY <br />ewo Mue fi118f200B ' <br />TO 39Vcl Hd 9NI2133NI9N3 DI13 OZL6Z099Z6T 80:ZT 9002/OZ/TT <br />