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��d/18/2006 10:59 FAX <br />DATE RECEIVED( EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />Y:NVIRONMENTAL HEALTH D PE ARTMENT <br />J,4td 1�7 �', East Weber Avenue, : ( Floor, Stockton, b: ww.sjg2708 h �� <br />nTeQepLone: (209)468-3420 Fu: (209) 464-0136 Web: www.sjgov.orgJehd <br />ENVIRONMENT HEALTH <br />PFRMIT/SERVITUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: MA4SJ t&CO'SIOS BUSINESSIAGENCY:_ &L ff N <br />!I <br />Z 002/002 <br />ADDRESS: <br />PHONE0 <br />fit/ 9`{8•- I3ys' PHONE (2): FACSIMILE: 121). 1 <br />TENTATIVE* APPOINTMENT DATE: 2.1 ( /h(o Time: (Z— _ <br />(Please allow 10 business days from date of application submtdal • `Tentative only -must be confimled) <br />0 CHECK BOX TO EXPEDITE REQUE§:T - $93.00 FEE (,ASH OR CHECK ONLY) - REQUEST PROCESSED IN $ BUSINESS DAYS <br />SIGNATURE OF APPLICANT kat"�[//54C/�(�� DATE 18/ 0G_ <br />Specific Date Range of Information Requested: Prom to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />of UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ARATEMENT _W SOLO WASTE FACIUTYIVENICLF <br />t&OTHER CLEANUP SITE(NoN-LOP) OFOOD FACAfTY ❑WASTE TIRE <br />IKUIIDERGRDUND TANK (MONITORINGIREMOVAL) C] DOG KENNEL '7 DAIRT <br />1111 HAZARDDUS WASTE GENERATOR ❑ CHICKEN RANCH ASTEWATER TREATMENT PLANr <br />0 TIERED PERMrrED FACILITY 0 MOTEiMOTEL O�{ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />171 TATTOOIBODY PIERCING 0 POOLISPA )Q LAND USE APPL=AT*M SITES <br />0 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVARARLE FOR REviEw - MONDAY -FRIDAY e:DO AM-6:0DPM - F CLUDING HOUDAYS. <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) 48x-0138 or mail to the vddress <br />Indicated above. Address ranges will not be accepted —for additional assistance with file addresses, contact <br />the EHD, Applications received after $:DO 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 flies 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 />EHD1 <br />IWW4AA6 <br />►��� <br />®�h <br />Specific Date Range of Information Requested: Prom to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />of UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ARATEMENT _W SOLO WASTE FACIUTYIVENICLF <br />t&OTHER CLEANUP SITE(NoN-LOP) OFOOD FACAfTY ❑WASTE TIRE <br />IKUIIDERGRDUND TANK (MONITORINGIREMOVAL) C] DOG KENNEL '7 DAIRT <br />1111 HAZARDDUS WASTE GENERATOR ❑ CHICKEN RANCH ASTEWATER TREATMENT PLANr <br />0 TIERED PERMrrED FACILITY 0 MOTEiMOTEL O�{ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />171 TATTOOIBODY PIERCING 0 POOLISPA )Q LAND USE APPL=AT*M SITES <br />0 MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVARARLE FOR REviEw - MONDAY -FRIDAY e:DO AM-6:0DPM - F CLUDING HOUDAYS. <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) 48x-0138 or mail to the vddress <br />Indicated above. Address ranges will not be accepted —for additional assistance with file addresses, contact <br />the EHD, Applications received after $:DO 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 flies 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 />EHD1 <br />IWW4AA6 <br />