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DATE RECENEO EHD LOG NUL, :R <br /> E��r���,' 1=D SAN JoAQUAY COUNTYlJ ElN TRONWNTAL MALTH DFWA.RTMTNT <br /> 304 East Weber Avenue, 3`a Floor, Stockton, CA 95702-2708 l L <br /> JUL I I) ZOOb Telephone: (209)468-3420 Fax:(209)464-0138 Web. 'AMW.sigov.orglchd �( <br /> ENVIRO ;",I—U T HEALTH <br /> I PLBJaIC RE CORDS RELEASE APPLICATION <br /> 1 _ <br /> ^pt_�•61T In <br /> APPLICANT. Le Cheney BUSINESStAGENCI': Ke110..Anderson &Associates;lac:. <br /> ADor:ESS: <br /> PHOtFE(1):_ 9'_^ GT.��Zk'�� PHONE(21, FACSIMILE: 209.364-4223 <br /> TENTATIVE*APPOINTMENT DATE: JuiK�2w, 2006 -Term:_ 0_2RL_,_, <br /> (PleaS9 all"10 businasa days from dere of application submNtal-*TCDar by onf$-masa be�7nd , c d) <br /> C7 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-RECIUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGHATURE OF APPLICANT � --DATE :jyyJO 2006�� <br /> UNIT DI,sTRInUTION to UFA1 ❑ Unit 2 ❑Unit 3 ❑Unit 4 Gl Unit ❑ Unit6 ❑ Other{elczcironlcliistslmepsJ �.e. <br /> FILE ADDRESS EHD USE <br /> 9tleEt# Stmet Nares CI <br /> 1. 500 $ i3eclaoem Raec Lodi l <br /> 2. <br /> 4.4.7.8. <br /> 9. <br /> 10. <br /> Speoffle Date Range of InlermatlUn Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROURD TANK(UST)CLEANUP SITE(LOP) E7 HOUSING ADATENEW ❑SOLID WASTE FACIJTYWODCLF <br /> OWER CLEA14UF Sr,E(NON-LOP) 17 FOOD FACILITY 13 WP.s1E TIRF <br /> ILUNOERGROUND TANK(t rMORINOIReMOVALI E3 DOG KENNEL t7 DAIRV <br /> HAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH ES WFSEWATER TR6ATdM PLIANT <br /> 0 nEnea PLnmrnT D FACRrrY Cl MOTELIHOTEL E3 PUMPER TRUCKIYARDICHEM TOILETS <br /> Q TATTOOfBODY ft=NG C7 POOLISSPA El LAND USE APPU;ATIDN SMEs <br /> 11 MEDICAL WASTE FAVRM'Y 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Revieri- MONDAY.FRIDAY 6:00 Am-SMPM - EXCLUDING HOLWAYS.. _ <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. );ax to(2099 464.0128 or mail to the address, <br /> )ndicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the rHD.Applications received after 3:00 pm will be processed the next busiDess day.. <br /> 2. The EHD wM 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 revloww. Appointments should be scheduled accordingly. <br /> S. AMP that is actively Going worked on by EHLI staff may not be immediately available for revlow. Anew <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 ar:tie expense of the <br /> applicant. Future file reNdews by the same applicant may require a$93.00 deposit prior to review. <br /> M7NJ6 <br />