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May. 18. 2006 9:52PM Advanced GeoEnvitonmental No. 4936 P. 2 <br /> (�JATE RECEIVED I5 0 SAN JOA UIN COUNTY EHO LOG NUMER <br /> n E� VMO ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAY Z 0 L006 Telephone: <br /> East Weber Avenue,3 d Floor, Stockton, CA 95202-2708 //� //�1 07 Iq phone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehdZ <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION _ <br /> P ^ _ <br /> APPLICANT: U h Q' 1 BUSINESS(AGENCY: WoancgbQ P 1 .• <br /> ADDRESS: 1 8 Q 1ST-O WCA (45a 1 S <br /> PHONE(1): 96 p- ! -IM& PHONE(2): 001- 71V - � / K FACSIMILE: Q6?- <br /> Oe' _7-d—J <br /> CIP <br /> TENTATIVE'APPOINTMENTDATE: 2q OD& <br /> Time: 140:00 Ailk . <br /> (Please allow 10 business days from date of appl Ion submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE E T-Sfr3.00 FEE(CA CH r�,K�O,�NL��Y)--,�R,,EQUEST PROCE45ED IN 3 BU$IN S$DAYS <br /> SIGNATURE OF APPLICANT VLY-f1L DATE <br /> UNITDISTRIBUTION ❑ Unit ffUnIt2 ❑ Unit3 0 Unit 0 Units 0 Unit 0 Other(e�lectroon1-o18stst6imap6)– <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name city <br /> 1. '711 Fa6v Mulerw <br /> 2. eSl- 141MUMV <br /> 3. f 0 0 1f it <br /> 4. 1 <br /> 5. URAM!T <br /> e C' <br /> 6. <br /> C <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C2HOUSING ABATEMENT ❑SOLID WASTE FACILfiYNEHICLE <br /> THER CLEANUP On(NON-LOP) 0FOOD FACILITY 13 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIIRRMOVAL) ❑Doe KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR EI CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑MOTEJHOTEL ,0.f PUMPER TRUCYJYARDICHEM Ton.FTs <br /> O TATTOOIBODY PIERCING 0 POOUSPA pLLAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) / ' <br /> WELL AND SEPTIC PEK411T RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AMfi:OOPM - EXCLUDING 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 filo 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 wlli be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five buscr:asa <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 /> i( t - <br /> EHD MAZ•Wa <br /> 1n�lOS <br />