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FEB. B. 2006 9: 16AM CONDOR EARTH TECH N0. 5527 P. 2/2 <br /> IILL��S;PID SAN JO.A.QUAv COUNTY EHD LOG NUMBER <br /> EN oNMENTAL HEALTH DEPARTMENT <br /> ES — 8 0006 pbo East Weber Avenue,3a Floor,Stockton,b: ww.sjg v.or �] <br /> 708 <br /> 'Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 2 efii •'ASA JPIf J1 ,B`USI-N-ESSII{AG/�ENCY: WPI <br /> ADDRESS: �I qUS .ff�KFNYic • 6keJC. LLG� FGTa-A, CA <br /> PHONE(I): IXO9'"<WcF^OS t PHONE(2): .209 ' (SO7 X X7.2(7 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Thnc: <br /> (Please allow 10 business days from q of application submittal."Tsntadve only-must be confirmed) _ <br /> CHECK BOX TO EXPE RE EST-$AF4( H R CHECK ONLY)-REQUEST PROCESSED IN 3 BUS S <br /> SIGNATURE OF APPLICA TZI <br /> DATE <br /> UNiT DISTRIBUTION ❑UnR1 ❑Un$2 Unita ❑Unit4 ❑Unit ❑ Unite C Other(electronldlists)maps) <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street Sheet Name city <br /> 1. <br /> 2. �t <br /> 3. r1 <br /> 4. _ 01 <br /> S. <br /> 6. <br /> 7. <br /> 6. b fJk4 <br /> 9. (tt 7, <br /> Specific Date Range of Information Requested:From to <br /> �� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IV UNDERGROUND TANK(USY)CLEANUP SRM(LOP) HOUSING AGATEMENT OLID WASTE FAgnTYNEHICLE <br /> �RTHERCLEANUP SITE(NOR-LOP) OcD FAcILRY 0WASLETIRE <br /> UNOERGROUND TANK(MONIORWG/REMOVAL) OGKENNEL ❑DAIRY <br /> �HAZARDOUS WASTE GERERATOR HICKEN RANCR ❑WASTEWATER TREATMENTPI.ANT <br /> t7 TIERED PERMITTED F=UTY ❑MOTELMOTEL ❑,�/P�UMPER TRUCK(YARO/CHEM TOIL <br /> ❑'rATTOO1BObYPIERCING ❑POOLISPA a�LAND USE APPLIOATION SITES <br /> 0 MEOICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC R£COROs ARE AVAILABLE FOR REVIEW• MONDAY-FRIDAY 0:00 AM-6i0OPM - EXCLUDING HOLIDAYS, <br /> I. List up to ton 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)46447138 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 END 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 /> y . <br /> EMDY-02-0K <br /> iMd06 <br />