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DATE RECEIVED <br /> �/j(� SAN JOAQUIN COUNTY � EHD LOG NUMBER <br /> REEE V ED ENMRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> AUG 2 2 2006 i} <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd 3 2/ <br /> ENVIRON6IE11 HEALTH PUB <br /> FRVICFS LIC RECORDS RELEASE APPLICATION <br /> fR�11T/S <br /> APPLICANT: � C�i -fit A BUSIN <br /> ESS/AG <br /> ENCY: '5 <br /> ADDRESS: q0�4 VTw'_T hGa)'_S Qk ©rz. S—t -1¢R4.9f�'/�• �'},SZI`� <br /> PHONE(1): PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DRAYS <br /> SIGNATURE OF APPLIC ���—� DATE S-27 �l0 <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronio/Iistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> street 0 Street Name City <br /> rV 1. tai w > A S <br /> 2., <br /> 3. � <br /> 4. ; <br /> 5. <br /> 6. <br /> 7. <br /> AUG 3 1 Z006 <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> .. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 173 DOG KENNEL 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR 13CHICKEN RANCH 13WASTEWATER TREATMENT PLANT <br /> 4 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-S:OOPM - 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 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 the <br /> applicant. Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD 4"G <br /> WING _ - -�— <br />