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12/12/2006 09:24 13107982841 PAGE 02 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> DEC 2 12006 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENT HEALTH 304 East Weber Aven{�e,3''Floor, Stockton,CA 95202-2708 7h3 <br /> PERMIT/SERVICES Telepbone:(209)468-3420 ax:(209)464.0138 Web:www.ijgov.org/ehidPUBLIC RECONS RELEASE APPLICATION <br /> APPLICANT: HeOli"�IeY .rllC�'IEAQICy BUSINESSIAGENCY: .AlI rxi1.sukh w+v <br /> ADDRESS: 2SQ0carA(A0 Diablo 1,t J,nt_r� C>�r? CA-SLSM <br /> PH0NF(1): f9 ZZ 2cj3-(PO PHONE(2): FACSIMILE:C7M (1(1'2595 <br /> TENTATIVE"APPOINTMENT DATE; A rime; <br /> (Please allow 10 business days from da td of application submittal•'Tentative only-must be conamned) <br /> CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED tN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �T�/� .b_ _ DATE 11 Z <br /> Electronic Information: E]List❑Map—Desc✓iption: <br /> FILE ADDRESS EHD USE,ONLY <br /> street Street Name _ city ❑ Unit <br /> 1. gob <br /> 2. <br /> ❑ unit2 <br /> 3. <br /> 4. RUnIt 3 <br /> 5. <br /> 6. i unit <br /> 7. <br /> S ❑ Unit 5 <br /> 9. <br /> 10. Units <br /> Specific Data Range of Information Requested:From q to pafn'- !1 <br /> ENVIRONMENT L HEALTH DEPARTMENT FILES <br /> WUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ 1,ousimo ABATEMENT XSOUD WASTE FACILnYNEHICLE <br /> WOTHER CLEANUP SnE(NONLOP) ❑F 000FACILnY �WWASTETIRE <br /> (UNDERGROUND TANK(MOMMORINGBEMOVAL) ❑ aG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑C HICKEN RANCH SLWASr WATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTO0n3ODv PIERCING AOLISPA ❑LAND USE APPLICATION SREs <br /> [3 MEDICAL WASTE FACILITY InCTRER(PLEASE SPECIFY) <br /> WELLANDSEPTIC PERMITRECORDS ARE AVAILABLE;OR REVIEW . MONDAY-FRIDAY 9:00 AM-s;eoPM • EXCLUDING HOLIDAYS. <br /> t. List up to tan addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. ax to 209 464 or mail to the address IndigzIteid above. Address <br /> ranges will not be accepted—for additional assists ce with file addresses,contact the EHD.Applications received after <br /> 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 approximately tan(10) <br /> days after receipt of application. The files will be held for a maximum Of five business days for review. Appointments <br /> 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 application may be <br /> submitted when the file is avaliable. <br /> 4. Any file not returned in the same condition as rel0a s6d will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may raqu re a$95.00 deposit prior to review. <br /> EHD USE ONLY <br />