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ue/Vl/GUUD 10:U4 PAA VZ004ZZUZZ UUKP.LAW Lgj UU1 <br /> tT1U LVli NVMIJCtt <br /> DATE(RECEIVEb ,SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTV DEPARTMENT <br /> 304 East Weber Avenue, 3rd floor,Stockton,CA 95202-2708 <br /> Juli Z 2005 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www SJgov.org/ehd <br /> 1"7 <br /> ENVIRONMENT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSI.4 STAG-, I. U'V r m Kc <br /> © ) 'tel /Af �n <br /> ADDRESS: <br /> (An�� �PHONE(2): FAcsIM1LE — <br /> PHONE �' Time: //� <br /> TENTATIVE"APPOINTMENT DATE:_V L� f_T,'y. ''� <br /> (Please allow 10 business days from data of appllcabon SUDmiB21-•T REQUEST <br /> only-must be D IN 3 BUS <br /> 0 CHECK BOX TO EXPEDITE EQ ST-897.00 FFE CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> Dari 0 r QS <br /> SIGNATURE OF APPLICANT <br /> UNIT DISTRIBUTION ElUnit 1 O UTTit 2 nitSM UnR ❑Unit 5 Unit 6 OUTer(elactfOniclllsWmaps) <br /> FILE ADDRESS city EHD USE ONLY <br /> street>f street Name <br /> A. '0 r r <br /> 2. <br /> 3. <br /> 4. <br /> S. <br /> 6. <br /> 7. <br /> 8. <br /> 9. e <br /> 10. �DtD C�-n f <br /> Specific Data Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES Eo wnsre FACIuttNEHICLr <br /> ❑HOUSING ABATEMENT ❑wAsm Tum <br /> yy5� UNDERGROUND TANK(USTI CLFANDP SITE(LOP) 0 Pow FACILITY <br /> $1�UNDER CLEANUP SITETANK <br /> (NONrT OP) ❑DDG KENNEL ❑DAIRYST <br /> I,al <br /> UNDERGROUND TANK(MONITt7mNGJrEMOYAL) MCHICKLM RANCH ❑WPSTEWATER TREATMENT PLANT <br /> 11 HAiARDOIJ9 WASTE GENERATOR ❑fMOYEt/HDTEL ❑PUMPER TRUCICNARD(CHEM TOILETS <br /> O TIERED PERMITTED FACILITY ❑POOLISPA LAND Usti APPLICATION SITES <br /> TANTOOMODY PIERCM0 ❑OTHF.A(PLEASE SPECIFY) <br /> El MEDICALWASTE FACIUTY MONDAY-FRIDAY 8:00 AM-5:ODPM . EXCLUDINO HOLIDAYS. <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REY•EW- of files from the list above by checking the <br /> I, List up to ten addresses in the space above. Select the type(t) <br /> Appropriate box(es). At least one file type MUST be selected. Fax to 209 464^D138 or mail to the address <br /> ition <br /> indicated a�iicatAddress ranges lans received after 1ll not be accepted–for 3:00 pm wll be processeddthe next business day.a,assistance with file addresses,contact <br /> the EHD,App ointment for review will be confirmed <br /> 2. The EHD will notify the applicant If any EHD files exist- An app <br /> Approximately ten(t o)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. available for review. Anew <br /> 3. A file that is actively being.Worked on by EHD staff may not be immediately <br /> - application may be submitterwYh2n the file is available. <br /> 4. Any file not returned in the same condition as will <br /> require b -Ma$93.00 deposit prior to rganized by EHD Staff ateview nee of the <br /> applicant. Future Acant may reviews by the same app Y <br /> END 49.02-M <br /> 111 o <br />