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02/07/2006 11:33 GEOMF' 'X-RANCHO CORDOVA 4 12094640138 ND.081 902 <br /> I ( 3/ � 640131 ENVIRONMENTAL HER PAGE 01 <br /> R L-- a SAav Joy Qrniv COUNTY <br /> 7 �0 ENVIRONMENTAL HEALTH DEPARTMENT ; Uwt)M, 04); ue,3d Flaor, Stockton,CA 95202-2708 <br /> ENViR0 ENT HEAI_ThfelePhDne: (209)4 68-3420 Fax: (2 09)464-0)38 Web; www.sjgov.org/ehd <br /> PERhAIT/SERVICES PLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 6 <br /> y� L BUSINESS aGENGY: (dCO+ rr'f <br /> ADDRESS: b /a6 1VpOw^T ja0e y_ P Ol. `*/Q o ciTY " et odO tr ! STATE CA <br /> PHONE(1) PHONE(2); NIA FacSWILE: 91.G 6 3 6' $Z G 8 <br /> TENTATIVE'APPOINTMENT DATE; /MA Id %""• 13 Zoog Ti,, G 90 C <br /> (Piam allow 10 business days from date of aff cation submittal•1Tvntati%v only-must be confirmed) <br /> WCHECK BOX TO EXPEDITE REQUEST,$91.00 FEE(CASH OR CHECK ONLY).REQUEST PROCESSED IN 9 BUSINESS 11AYS <br /> SIGNATURE OF APPLICANT DATE <br /> List <br /> ElRctronle ❑ Lst ❑ Map P-Posoriptlan <br /> FILE ADDRESS EHD USE ONLY <br /> street0 Street Name City <br /> 1. I2lnl as fwA ti Row pt kb cr ❑ Unit 1 <br /> �. <br /> 3. <br /> a. Unit 2 <br /> s. e Unit 3 <br /> s, <br /> �. jeUnit 4 <br /> 8JO <br /> ' <br /> 8. O Unit 5 <br /> 1D. 'WE Unit 6 <br /> Specific Date Range 0f information Requested:From mc to eee,% <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XUNDeROROUNDTANK(U$T)CLEANOPSITE(LOP) ❑ HOUtINOAaATEVENT 1F SOLD WASTE FACILITYNEMICLE <br /> 19 OTHER CLPARUP&ITE(NON-LOP) GFOW FAcam 0WASTE TIRE <br /> 0 UNDERGROUND TANK(MONnOR1RetRENOVAL) ❑boC KENNEL ❑ DAMY <br /> IV HAZAROOUS WASTL OENEnATOR ❑Cmrcl x RANCH ❑WASTEWATER tREATMEKT PLANT <br /> IR TIERED PERMITTED FACILITY 0MOTELIHO114 0PUMPERTRVCK/YAROICHeVICALTDILETS <br /> ❑TATT'OOIMODY PIERCM9 ❑PQQUSPA 'jt`LAND USE APPLICATION SUES <br /> 0 MEDICAL WASTE FACILITY O OTHER(PLEASE SPEDIFYI _ <br /> WELL AMP$EPTIC PERMIT RECORDS ARE AVAILABLE FOR REv1EW -MONDAY.FAIDAY 8:00 AM-6:DOPM . EKCLUMamO HOLIDAYS. <br /> 1. Ust up to ten addresses 1n.the space above. Select the types)of files from thz list above by checking the <br /> appropriate box(es). At least one rile type MUST be selected, Fax to(20914640138 or mall to the address <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 EMD will notify the applicant if any EHO 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 review. Appointments 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 <br /> application may be submitted when the file is available. <br /> 4. Any file hot returned in the same condition as released will be reorganised 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. <br /> j <br /> r <br /> ,�JILL <br /> ENP t6-0C � <br /> 10.n112006 <br />