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09/29!'2006 11:29 F.h3 <br /> FHv�_q3 Pd' P.4BEF <br /> N _6VED _rSAN JoAQuCOUNTx <br /> EN _ -SAN <br /> HEALTH DEPARTMENT <br /> �Q06 304 vast 4beber Avenue, 3"t Floor, Stockton,CA 95202-2708 <br /> P 2 9 hone: ^OiT 468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd1 r <br /> SE Telep (.- , <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICA'T`ION <br /> AP''�CANT: !'e tc S"- I�en�"�w1�4T-4SU* BUSINESS/AGENCY: <br /> ADDRESS:, 3LIi0 G) ffi ,heA- <br /> f ) -- <br /> PHONE(1): 1209' Z3r{-7T2Z PHONE 2:11(6� �'i7-7fa6 FACSIMILE: <br /> TENTATIVE*AAFPOiNTMENT DATE: Time: <br /> (Pieass aUcw 10 business days from date Of apprlcatien submktal-•Tentative only-must be c"fjnnad) <br /> fik.E.'CH 50Y TO EXPEDITE RE7 ;X583. (CA$1{OR Q}iECK ONLY).REQUEST PROCESSED IN 3 BljsiNEo3 DAYS <br /> SIGNATURE OF APPLICANT % x ®—" DATE <br /> \ 4r <br /> UNIT niSTftiaUTIQN u C Unkt C Unk2 C UnkS C Unk4 C Unk6 C UN.t6 C Dater(e'ectronic'lists/mapa) <br /> FILE ADDRESS _ EMD USE ON <br /> 2 040O..5 eecN Stmet Name ..... .Gky <br /> 1 <br /> f 1 rD �r�RfaltSE ?Jcg06 Trgc� ItST _ <br /> 2 tel ' 4n1tRCAkTtiAA21 frwcr 1� <br /> -- - — <br /> 5 5�,a r,Rc'L�1t UnaF H <br /> --PZ 4 7<.1 C T U IPE..tki). E 424 <br /> 5 5 t QLiS i..00F 205 W Sl547-_. TrA'.Cy <br /> 72MO 6 2�0GNi to iAU �D.e.. 239pt_.. I Tfac.� iyY - \�R <br /> 77-17 <br /> al�rj i -7 �S ' n1 ELEV t1V, ST -+&f irc« <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �D <br /> t.;KDERGROUND TANK JUST)CLEANUP SITE SLQF) 0 HOUSING ABATEMENT ' <br /> IT�J�OTHER CLEANUP SITE(NON-LQP) in FOOD FACILnY <br /> NDERGRDUND TANK(MONITORINGIREMOVAL) ODoG KENNEL <TREpT69ENT PLANT WASTE GENERATOR 13 CHICKS CH <br /> TIERED PEFWVTTED FACILITY Omrs L -.KIYARDICHEM TOILETS <br /> ❑?AT r001soeYPIERCING 13POOLIS r APPLN:A7)ON SITES <br /> 0 MEDICAL WASTE FAcruTy OCTHER( L <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE rOR RENEW- MO - PAT-5:Q0. - E%CI. JSNG HOLIDAYS. - _ <br /> 1, List up to ten addresses in the space above. Select the a of fil f Is the list above by checking the <br /> appropriate box(es). At least one file type FAUST be select Fax to 0 464-0138 or mal to the-address <br /> indicated above. Address ranges will not be accepted-for additions assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EH7 will notify the applicant if any EHD files exist. An appointment for review will be confirmed Q <br /> apprcxirnate!y ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> aa,I; TTcr pv(H+r+. AppoIntmsnts should be scheduled accordingly. <br /> 4,fsie x nv is active.q Seing"orl:ed on by EHL?staff may not be immediately available for review. A new <br /> appiic2tlen 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 prior to review. _Jl <br /> a»4sn eye <br />