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LFR 3x:5106524906 Nov 30 2005 16:31 P.01 <br /> DATE RECEIVED SAN O <br /> AQUIN COUNTY�/J{ FHD LOG NUMBER <br /> CE 1% Lam® ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 I �� <br /> NAY 0 2005 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/chd <br /> ENW-rn A144�qFR­FW- <br /> VIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ''//__ <br /> APPLICANT: ' NI BUSINESSIAGENCY: Li:V1V.G. F1-CV-G LFP. <br /> ADDRESS: x(900 owtu 5-V )2tk .lpa- <br /> PHONE(i): S(n` Iaaf—' 1663 PHONE(2): FACSIMILE: ^)y b-66L4606 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$83.00 F R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE hlse466 <br /> UNIT DISTRIBUTION D V tEl <br /> Unit 2 CI Unit 3 0 Unit 4 0 Unit 5 ❑ Unit 0 ❑ Other(electronlefftWmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 1f Street Name City <br /> 1. o P. <br /> 2. -77-1 <br /> 3. <br /> 4. <br /> IL <br /> 5. <br /> 6. <br /> 7, <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From _ (940 to 208 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT C SOLID WASTE FACILTTYIVEHICLE <br /> OTHER CLEANUP$ITE(NON-LOP) 17 FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONRORINeIREMOVA_) CI DOG KENNEL 0 DAIRY <br /> %HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> C TIERED PERMITTED FACILITY 0MOTEMOTEL O PUNPeR TRUCK/YARDfCHEM TOILETS <br /> G TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Review- MONDAY.FRIDAY 8.00 AMS:OOPM . 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to f209)464-0138 or mail 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 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 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 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. <br /> EHDae.oz.oa <br /> 1MNN45 <br />