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02/13/2006 16:23 __ 510-4376 PSI INC PAGE 01/01 <br /> 1f11RE�- '�U 4 76ED SAN JOAQUXN COUNTY EHD LOG NUMBER <br /> EAMENTAL HEALT)I DEPARTMENT <br /> FEB1 3 COCl 304 Eastast Weber Avenue,3'd Floor, Stockton,CA 95202-2708 <br /> ENVIRONMENT HEALTH Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/chd <br /> PERMIT/SERVICES p ELIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Mr Drrdu. 5;6MC _ 13USINEWAGENCY: f!E r . iif'�_ <br /> ADDRESS: f70Z rza"akr• 4&t- � /& A, Date6a ,eA 4YU01 <br /> PHONE(1): bio-L17Y-gZdU x 17 PHONE(2): FACSIMILE:/ ?D—rl4-7G7G <br /> TENTATIVE"APPOINTMENT DATE: �y/ac4 _ TillA&—ritdoK <br /> (Please allow 10 business days from date of a pllcatfon SubmiCal-"Tenfafim only-must be confimled) <br /> CHECK BOX To EXPEDITE REQUEST-$93.00 E(CA CHE ONLY)-REQUEST PROCESSED IN 3 BUS ESS DAYS <br /> SIGNATURE OF APPLICANT va��" DATE - 2 <br /> UNIT DISTRIBUTION 0 Units ❑ Unit2 ❑Unit 0 unit 0 Units ❑ Unita 0 Ottler(electrunlcmisrannapa) <br /> FILE ADDRESS EHD USE ONLY <br /> SUs" <br /> Street Nana City <br /> l2o C �� #s 1 <br /> 3. SD f' <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> s. <br /> 9. firm <br /> 1d. <br /> Specific Date Range of Information Requested ,.,ro, to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLIDWASTE FACILITYINENCLE <br /> 0 OTHER CLEANUP SITE(NOWLOP) ❑FOOD FACILITY d wASTETRE <br /> UNOgtGROUNO TANK(MOn1TOWNGIREMNAL) ❑DOG KENNEL 0DAIRY . <br /> HA7ARDOU9 WASTE GENERATOR C3CHICKm RANCH ❑WASTEWATER TREATMENT PLANT <br /> 13TIERED PERMITTED FACILITY 0 MOTELIHOTEL O PUMPER TRUCKfYARD/CHEM TOILET$ <br /> 17 TATTOO/BODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION Snrs <br /> ❑MEDr-AL WASTE PAciurY 13 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR R51EW- MONDAY-FRmAY 8:00 AM-5:00PM - F XCLUr1Na HOLDAYS. <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 rile type MUST be selected. Fax to(209)464-0138 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 he 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 /> �1 <br /> p .I kvv <br /> r.::.^�-'ail\ •=J <br /> END 2-0 <br /> III,)" <br />