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DAM RECEMM <br /> �� �D STAN JOA.QUIN COUNTY EHD LOG NUMBER <br /> t�JD�JJ v���nEN rmoNMEN'TAL HEALTH DEPA1zT5IENT <br /> 3 'Av�w.sjgov.org/chdZ <br /> East Weber Avenue.3"1 Moor, Stockton, CA 95202-2708 � �� <br /> MAY 3 1 Z�ephoae: (209)468-3420 Fax: (209)464-0138 Web: w.sjgov.org/chd <br /> AP3y <br /> ENVMMM"' HLIC RECORDS RELEASE APPLICATION <br /> ARCIWDave <br /> ADDRESS: 90 9U9INESAGENCY: <br /> ,Nell OAnderson&Ass—a <br /> cla, n , <br /> rd <br /> _ <br /> PHONE('):- 129-36]-37_0PHONE(2): F4•cs@il-r. 209-369.4223 <br /> TMTATIVE"APPOINTMENT DATE; June 14 2006 —Tlma:_9:00 am <br /> ew <br /> (Pla allow 10 businaas days from data of applkx0on auDmRtai•'renladl2 only-must be conflmLad) <br /> E3 CHECK 13OX TO EXPEDITE REQUEST-;93.00 FEE(CASH OR CHECK ONLY).REQUEST PROCESSED RV 3 EUSINESs DAY. <br /> SIGNATURE OF APPLICANT DATE May 39, 2006r <br /> UNLIT DI$TRIaUTON GUnat OUnit2 0UnIt3 CUOK4 OUnns 0 UnttO C3 OWVr(alectMnlGO maps) <br /> FILE ADDRESS EHD USE ONLY sDaats sDaetRome city <br /> -1. 9015 Walnut Ora •)7;mwn <br /> 2. <br /> 3. — <br /> 41 <br /> 6. <br /> 7. — <br /> 8. <br /> 9. — <br /> Specific Date Renge of Inforrrlation Requested:From to <br /> ENMRONMENTAL HEALTH DEPARTMENT FILES <br /> E7 UNOEROROUND TAI+K(UST)CLEANUP SITE(LOP) 0 HousmO ABATEMENT 0 SOLID WARTS FACMylVmncLE <br /> E7 OTHER CLEANUP SITE(NPN-LOP) 0 FOOD FACILITY Q WA=-TIRE <br /> ID UNDERGROUND TANK(WNRORINGIREMOVAL) O DDG KENNEL t3 DAIRY <br /> M HAZARDOUS YYASTE GENERATOR O CHICKEN RANCH 0 WASR:WATER TREATMENT PLANT <br /> 0 TIEREDPERMITTED FAciuly 0 A40TEUHOML 0 PUNPCRTRUCKIYARDfCHVA TOILET& <br /> U TATTOOSCOT RGRCING ❑POOLISPA 0 LAND USE APPLICATION SITES <br /> ElMEDICALWASTEFACILITY IDOTHER(PLEASESPECIFY) SBDOCOk&.maWmede�a <br /> WELL AND SEFTIC PERMITRECOROS ARE AYAILAGLE FOR REVIEW- MONDAY-FRIDAY 8*0 AM-6:001M - EXCLMNG 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(209146"138 or mai(to fire add -;s <br /> Indicated aMve, Address ranges will not be accepted–for additional assistance with f(ie addresses,contact <br /> the END.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 exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for radiew. Appointments should be scheduled accordingly, <br /> A file that Is 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 returned In the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant, Future fila reviews by the same applicant may require a$93,00 deposit prior to review, <br /> ENDA&02 <br /> 114100 <br />