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02/13/20n0,611 16:23 51.0-4,4676 PSI INC 41 PAGE 01/01 <br /> RU ��1}gI�y`4khIE D EHD LOG NUMBER <br /> If�J =V' t "'CCCfff•111777"'E SAN JOAQUIN COUNTY <br /> FEB3 0006 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 Fast Weber Avenue,3d F)oor, Stockton,CA 95202-2708 <br /> ENVIRONMENT HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sjgQv.org/ehd r <br /> PERMIT/SERVICES ELIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Mr. Srlo•LI. Synze.k-. BUSINESWAGENCY: PsZ_.:Au . <br /> ADDRESS: f70Z rdrwa rr Idle �S�z, A eA 5Y1n01 <br /> PHONE(l): 17 PHONE(2): FACSIMIM: ^S?D—trltf-7G7(� <br /> TENTATIVE"APPOINTMENT DATE: y L 11 Time: , r11_Rmn <br /> (Please allow 10 business days from date of a plleaflon subm ttal-"Tentafin only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 EE(C C' E'�ONLY)-REQUEST PROCESSED IN 3 BUS ESi PAYS <br /> SIGNATURE OF APPLICANT /_ DATE <br /> UNIT DISTRIBUTION 0 Unit I O Unit 2 ❑Unit 3 o unit 4 E3 Unit 8 O Unit 8 O other(electronlcnismAmps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. ztJN, /La C Z%a_4 <br /> 2. o- f S 5Ys 7" <br /> 3. SU is L <br /> 4. <br /> S. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested VION to <br /> ttL[��II ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> y.t UNDERGROUND TANK JUST)CLEANUP SITE(LOP) O HOUSINGASATEMENr 13 SOLID WASTE FACILTrylveNCLE <br /> Ct OTHER CLEANUP SrrE(NON-LOP) RFOOD FACILITY ElWASTETRE <br /> U NDERGROUND TANK(N0N1T01UNWP.EN?VVAL) ❑DOG KENNEL 0DAIRY _ <br /> HAZARDOUS WASTE GENERATOR 17 CHICKEN RANCH ❑WASTEWATER TREATmwT PLANT <br /> O TIERED PERMrrTED FACILITY 171 MOTBLIHOTEL M PUMPER TRUCKIYARDICHEN TOILETS <br /> ❑TATTOWBODY PIERCING 0 POOLISPA ❑LAND Use APPLICATION Sres <br /> ❑MEOIcAL WASTE rACILrY O OTHER(PLEASE SPEGFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW. MONDAY-FmoAY 8:00 Am-5:001FM - EXCLUDING HOIJOAYS. <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)4640138 or mall 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$93.00 deposit prior to review. <br /> .d <br /> EHoaeozaaa <br /> v+� <br />