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Jul- 13. 2006 2;53PM A <br /> DATE KtL;tIVtU ced GeoEnvironmental No, 5480. P, i <br /> AHD Lvv.tUNBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3r4 Floor; Stockton, CA 95202-2708 ~ <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/Chd� <br /> P <br /> UPLTC RECORDS RELEASE APPLICATION <br /> APPLICANT: V" h An BUSINESSIAGE(N�CY: <br /> ADDRESS: ��7j qq p //S ti 8Q STD r Ll <br /> PHONE(1): OI U ! - UP 77/00(9 PHONE(2): 90- 113 <br /> - ;W7V/ V FACSIMILE: 07 % ` V 17-Im /1 <br /> TENTATIVE*APPOINTMENT DATE: IT(9 /10 Ly p{DO67 CwejTime: IQAp- 6r-eO"rlheP <br /> (Please allow 10 business days from date of application submittal-•Tentative only-must be confirmed) ()= f aU <br /> CHECK EOX TO EXPEDITER DST-$93.00 FEE(C OR C ECK ONLY)-REQUEST PROCESSED IN.33 B SINES^DAYS � <br /> Si(3P�TURE OF APPLICANT DATE / <br /> UNIT D-STRIBUTION D Unit 1 d Unn 2 En Unit 3 0 Unit 4 173 Unit 5 173 Unit e 73 Other(9lectronfGltsts/maps) <br /> FILE ADDRESS EHD U5 ONLY <br /> Street 4 Street Name Ci <br /> 1. oa — <br /> 2, A qtI r1 tr t, <br /> — <br /> 4. ✓ <br /> a. e/ 2 `hD <br /> 6. e u <br /> 7. 1`t1L l C <br /> 3q Eas-F <br /> 8. 13 L4 a✓ 1 t k I rr <br /> 70. 24Df I InL\) Ve t <br /> >oPedfic Date Range of Informstion Requested: From __- DO5 to <br /> nfsr[E Qnl�y ENVIRONMENTAL HEALTH DEPARTMENT FILES " re <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOF) 0 HOUSiNo ABATEMENT 11 SOLD WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE <br /> E(NON-LOP) ❑FOOD FACILITY ❑WA9TE TIRE <br /> NDERGRO4 TANK(MONITORINGfREMOVAL) Q OOG KENNEL Q DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O WA'.TEWATER TREATMENT PLANT <br /> C]TIE RED PERMITTED FACILRY ❑MOTELIHOTEL C1 PUMPERTRUCKIYARDICHEM TOILETS <br /> ❑TATI'OOISODY PIERCING ❑ POOLISPA Tf L ND USE APPLICATICN181TES <br /> C MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) / <br /> WELL AHD SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - 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(209)464-0138 or mall to the address <br /> indicated above. Address ranges will not be accepted–for additional asslstance 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 lhay 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 tie <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review, <br /> EN04W.,000 <br /> 1H4Po5 <br />