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Sep 01 05 06: 23p Pal Humphrey _ (5591 226-3408 p. lt T / <br /> EHD USG NUMBER <br /> DATE RED SAN JOAQUIN COUNTY <br /> RECEENVIRONMENTAL HEALTH DEPARTMENT22 <br /> 206 304 East Weber Avenue,3'd Floor,Stockton,CA 95202-2708 <br /> Mpp, Telepbone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENT%HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PEAPPLICANT: BUSINESS/AGENCY: _ <br /> ADDRESS: G '' <br /> PHONE(1): SS /' �J )7 - PRONE(2): FACSMDLE: — <br /> TENTATNE'APPOINTMENT DATE ThnQ: — <br /> (Pius"sdbw 10 business days fmm CiMe of epptkam wbroYtel-'TenhUve or11Y-mud be Cordhrned) <br /> f❑ CHECK 80X TT)EXPEDITE REO 593.00 FEE ASH OR HECK ONLY)-REQUEST PROCESSED 1113 BUSINES7;DAYS <br /> SIGNATURE OF APPLICANT DATE 3 i5 v <br /> UNITDIST MOUT10N ❑Un t 1 ❑UFM 2 O Unit3 O Un 4 0 Una 5 13 UnK S ❑ 0IhW(ekw4cnic10etshmsps) <br /> FILE ADDRESS i?a96) EHD USE O <br /> salts fted Nemo __ taA <br /> 1. t ^ <br /> 2. ., " 3� <br /> �. - wi <br /> 5. - <br /> 6. - <br /> 7.. - <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of IMOnnatbn Requested: FILESo <br /> From t � Mel <br /> ENVIRONMENTAL HEALTH DEPARTMENT LES <br /> .151 UNDP.RCRWSO TANK(UST)CLEANUP SITE(LOP) O Housm AaATEMFNT 'FtSouDWASrE FAcEMYNEHI= <br /> O OTMFR CLEAKP SIE(No*4_0P) 0FOoo FACK,tt DEXp TIRE <br /> TAR 2 7 2006 <br /> UNDERGROUND TANK OG rOWWAIEMCNAL) 0DKENNEL <br /> HA2MOOIle WASTE GENERATOR ❑CHCMN RANCH 0 WASTEWATERTREAtMF]fTPIA <br /> ❑TIERED PEwnTPD FAc&m 0MOTELA40TEL G PUMPER TRUCKPYARDICHEM Tciv? s <br /> 0 TATTOWBOOY PIERCING 0 POM/SPA / q�ANq fif APPUGATION Snes <br /> O MEnicAI WA FACIun .EJ•OTHFR(PLFAsESPEaM ! ••••./�.`/�'� /BZS 9—Z /,go- <br /> 5-WELL AND SEPTIC PER w TICLOROe ARE AVAILABLE FOR REVIEW - MONDAY-FRMAY 8.00 AM-5:e0FM - E(MUI NG HOUDAr-L <br /> 1. List up to tan 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(2091464-0138 or mail to the Eldmss <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 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 fhfe business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHO 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 file reviews by the same applicant may require a$93.00 deposit pri x'to review. <br /> END u-0xsoe . <br /> 11i ms <br />