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- -------- ------- ...... .. . ................ -------- ---- _--- - - <br /> DATE RECEIVED END LOG NUMBER <br /> SAN J A UICOUNTY <br /> <.� <br /> ENVIRONMENTAL EALT[ EPA TMENT fr� <br /> 1868 East Hazelton Avenue, Stockton, GA 95205-6232 <br /> 3 :Tole hsDne: {20.9)468-3420 Fax: {209)464-0138 Web: .sjgov.org/ehd �' % l <br /> G{ ix t v <br /> LIC RECORDS RELEASEAPPLICATION <br /> APPLICANT: David pale 8USINESSIAGENCY:Bale and Associates <br /> ADDRESS: 104 Brock Drive CI I TATEJZIP:Wheatland, CA 95692 <br /> j <br /> PHONE (1): 530-415-6623 PHONE(2):530-633-0117 FACSIMILE:530-633-01119 <br /> TENTATIVE*APPOINTMENT DATE: 7116113 Time: PM (1-5) <br /> {Please a[low 10 business days from data of applicatlon submittal--rontatire only-must be confirmed) <br /> CHECK BOX TO EXPEDITECESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTREQ S -: FE A OR CHECI{ONLY)-REQUEST PRODATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name Gift it Unit 1 <br /> 1. 6750 South Longe Street Stockton <br /> 2. 7100 South Lenge Street Stockton ❑unit 2 <br /> . 7190 South Longe Street Stockton <br /> `1 <br /> 4. 767; South Longe Street Stockton CI unit 3 t (i <br /> 5. 1621 Citation Street Stockton I--IV's <br /> 6. 1641 Citation Street Stockton �j 0,unit 4 f <br /> 7. 6755 Dixon St(C.E.Dixon St.) Stockton <br /> P7/ <br /> S. 5000 S.Airport` a �« Stockton r <br /> p YEl Unit a <br /> 9. 1000 Lockheed Court � Stockton <br /> 10. 7611 S.Airport Way Stockton Q 6tnit s <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT"FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY X iJlPLID WASTE FACILITYIVEHICLE <br /> X OTHER CLEANUP SITE(Nom-LOP) ❑HOUSING ABATEMENT X ASTE TIRE <br /> X UNDERGROUND TANI((MONITORINGIREMOVAL) ❑FOOD FACILITY DAIRY <br /> XABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> X HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEtIHOTEL ❑PUMPER TRUCKfYARDICHEMICAL TOILETS <br /> X TIERED PERMITTED FACILITY POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIUODY PIERCING OMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY <br /> t} WEI L AND SEPTIC PERMIT RECORDS.ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 0:00 AM-5:OOPM(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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(20q 464-013R or trail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pro will be processed the next business day. <br /> 2. The END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately tan(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 EIAD staff n ay not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> d. Any file not returned in the same condition as released will be reorgani ed by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$123 deposit prior to review. '-BOXED AREA- FID USE ONLY <br /> 0 Reeords provide it I:iy Staff-PPR f:ortll ICAe. staff tg!,;,a: <br /> EHD 48-06 914112 <br />