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FROM ERAS Envl ronmantal, Inc. (WED)OCT T 2006 14:02/ST. 14:01/1,1 .7B0000o66e P 1 <br /> DATERE�ER„\\v'(n ^ SAN .IOAQUIN COUNTY EHD LOG NUMBER <br /> I(Irv1,1, U � �` <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 0 7 ZOO 600 East Main St. Stockton, 3029 <br /> elephone: (209)468-3420 Fax: (209)464-0101 388 Web: www.sjgov.org/e <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> O q r 490 <br /> r I <br /> APPLICANT: 1�) �O e— SINESS/AGENCY:&PA <br /> ADDRESS: I S'3,3 Q gy, 'ISTATEIZIP: Hty/(JyT <br /> PHONE (1): —d,2(y PHONE(2): 1`t�� FACSIMILE: 50-886—E-311 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Picea allow 10 business days from data of ap U soon submittal-• 1 nl ust be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST- 115 (C OR CHECK ONLY)-REQ S OCESSED IN 3 BUSINESS DAYS <br /> SIGNA URE OF APPLICANT DATE /0-7-01 <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street 0 Street Nattyfr city El unit 1 <br /> 1. k�L arc C_ —Sl'OG I f+ i <br /> 2- 32 CI C nit 2 <br /> 3. ap3Alle <br /> t'K it- 5 S <br /> 4• X03 F- Nlwtes- :Un <br /> S. 3W/ <br /> 6. <br /> 7. /' -Aw <br /> IJ <br /> 9. I' <br /> to. — U�11c OIS D°� ❑ <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSNiG ABATEMENT ❑SOLID WASTE FACIRYNEHICLE - <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> tNDERGROUND TANK(MONnORINGIREMOVAL)� ❑DOG KENNEL El DAIRY <br /> H zmwus WASTE GENERATOR p( ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLUM <br /> ❑TIERED PERMrTTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(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(20914640138 or mail to the address Indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received 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 for 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 file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. N you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD USE ONLY <br /> EHD 4MG M211e9 <br />