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05/31/2006 ED 10;44 FAI 55 7 2886 BSK Environmental X002/002 <br /> � iQ�QrL��/t(C�.�� M <br /> — "" E v ED SAN JOAQUIN COUNTY E.HO LOG NUMEF? <br /> MAY2006 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3d Floor, Stockton,CA 95202-2708 /� <br /> ENVIRONMENT HEXEMhone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd / 3 3 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION v <br /> APPLICAlir: )1cE M._(lEN-�,LG •p c =_ <br /> q BUSINESSIAGENCY:-BSIC A&ueuATt.__— <br /> ADDRE55[_c, �-J W S�{AL� A( Cl NVCI SL iTE +J �/t.Fsudr CA 9370 f/ <br /> PHONE(t):_5 rJ9. Y97.2•iao E'tLi iZ') PHONE(2�: S59. V79 d/Z FACSONLE. .? . 4 L <br /> TENTATIVE'APPOINTMENT DATE 6�/Y�oro Tom; /Dam <br /> (Please allow =trustness days from date Of applicatlon submlltal•"Tentadve only-mutt be D,,pmledj <br /> 0 CHECK BOX TO EXPEDITE yl $93.00 H OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE _ S"• 3 6 L <br /> UNET DISTRIHUTION ❑Unit 1 0Un Una3 0Un4A DUnit 6 O Unae D Omor(electrarictlEa�hlupsl _� <br /> FlL- ADDRESS <br /> 2 `3yp17, ✓ QA�✓c— Sz AUSF-0 - <br /> 4. <br /> 6.. 3�LB SS" �A✓Y MG•2-qA!ASp_clHc Date Rangeof Information Requested:From �/YO to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNmE ACUND Tawe(UST)CLEANUP SITE(LOP) O HOUSING ASATEMEW ❑SouD WA3re FAI NENIetE <br /> OTHER CL.€AIiUP SITE(NoN10P) ❑FOOD FACILRY 0 wAz,TE rIRE <br /> UNDEF.GROUND TANK(MONrmRINGIREMOVAL) E7 DOG KENNEL ❑Dwr"r <br /> HAZ CQS WASWGE Mmron ❑CHIp RANCN ❑W0.. ATERTRATYE> .PLAN': <br /> TIERED PERMITTED FACIuTY ❑MOTELIHOTEL ❑PUNPERTRMKrrA oK:NF_/r TOILETS <br /> O TATTDO)BOOY FTEmING 0 PDOUSPA ❑LAND USE APPLICAT N SrTn <br /> ❑MEDICAL WA FACILITY a OTHER(PLEASESPECIFYI <br /> WELL AND SSMC PERMIT RIIV tO a RE AVNLADLE fOR REVIEW• MONOAYfRIDAy$:OO AMS:OUPM • EXci.V0IN0 HOLIDAYS.'—_— <br /> t. 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(2091464-0138 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 atter 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 /> EHP•aLZ{OB <br /> 1(,iWS <br />