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SEP. 8200 2:39PM ERM ^RAMENTO tiC 662 P 1 <br /> n/7 EHD LOG NUMaER <br /> v l�9 SAN JoAQunv COUNTY <br /> SEP ENVIRONMENTALHEALTT3DEPARTMENT 11197 <br /> — P, 2005 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> ENVIRON" Telephone: (209)468-3420 Fax: (209)464-0138 Web:VAVW.sjgov.org/ehd <br /> m;EIVT HEALTH <br /> PERMIT;%SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: NESSIAGEBN MtJ,at tY^ONiM�n}7►1!L!<SI�Mc�j <br /> ADDRESS ?= ZS Akff ym a r P Sn s+wa <br /> PHONE(1):l4tL) J.� PHONE(2): r 335r ?--v FACSIMLE:CAP <br /> TENTATIVE'APPOINTMENT DATE LJ�'�� iiQyL!__. _Timor <br /> (Please allow 10 business days from nate of appbcatbn submittal-'Tenta6Pe only•must bo confirm <br /> L7 CHECK BOX TO EXPEDITE REQUEST-593.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION 11 Unit O Unit Unit UnR4 17 UnitS [3 Unit M Other(oloevonl�swmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> 1I W Set4et IF Stntet Hama city <br /> I LIST 1 U/ <br /> �) F 3 <br /> 4. <br /> 5. <br /> 7. <br /> e. <br /> 9. 11 <br /> 10. <br /> Specific Date Range of Intotmation Requested:From Idleo to F'Ze 4)'� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES , <br /> IVINDERGROUND TA (UST)CLEANUP SITE(LOP) D HOUSRIG A6ATEMENr M SOLD WASTE FACILITYNERCTE <br /> V] Qz CLEANUP SITE(NoN-LOP) C FOOD FACILITY O Wasre TRE <br /> NK <br /> DERGROUNOTAN (MOMTOSINGREMO'1AL) ❑DOG KENNEL ❑DAIRY _ <br /> KWASTE GENERATOR ❑CHICKEN RANCH ❑WAsT ATER TREATMEHr PLANT <br /> DM <br /> EKED PEMFwrrr D FACILITY O MOTEL HOTEL O PUMPER TRUcK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOVSPA ❑LAND USE APPUcATON SITES <br /> MEDICAL WASTE FACILITY D OTHER(PLEASE SPECIFY) <br /> WELL AND SEPnc YERMir RECORDS ARE AVAILABLE FOR RENEW - MONDAY-FRIDAY 8:00 ANti5:00PM - FxC umG HOLIDAY& <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 209 464.0138 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 th <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHo — <br /> Incos <br />