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02/13/2006 16:23 510-4376 PSI INC PAGE 01/01 <br /> iy�p(�E <br /> ll U EHD LOG NUMBER <br /> L a SAN EHD <br /> COUNTY <br /> Fig " 2006 East WANMENTAL IFEA,LTH Don,CA 9VxENT A �� <br /> ` 304 East Weber Avenue, 3'0 Floor, Stockton,CA 95202-2708 <br /> ENVIR0N,'':1E_H( i HEALTH Telephone;(209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd <br /> PEM'4l1/SERVICES gr/4Lu. <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT: IN('. gr/au. S�6mz k-- BUSINESSIAGENCY; fs7z - J to_ <br /> ADDRESS: Vo'2 ILY�z(er~ 61f4 �,ul.c, f3 l`7at.�k.c t Pte! fYrool <br /> PHONE(t): PHONE(2): FACSIMILE: <br /> __ry;tr'�Il��l-�G 7G <br /> TENTATIVE*APPOINTMENT DATE: y IY/bre Time: fltrr/Rob✓L <br /> (Please allow 10 buslnsss days from date of a plleatlon submittal-"Tentative only-must be Confirmed) <br /> /CHECK BOX TO EXPEDITE REQUEST.$93.00 jE( CHE ONLY)-REQUEST PROCESSED IN 3 BUSINESS GAYS_ <br /> SIGNATURE OF APPLICANT � DATE <br /> UNIT DISTRIBUTION 0Unit I E3UnIt2 0U&t3 I3UnR4 r3Unhs 0 UnitB o Other(electrenlcniatatinaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 2. s sty r <br /> 3. �U cGisn <br /> 4. <br /> a.- <br /> 6. <br /> 8. <br /> 9. <br /> 10, <br /> Specific Date Range of Information Requested ro to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLVANUPSITE(LOP) ❑HOU3mGABATrlrEw O SOLIDWASTe FAaLnY1VEl4CLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0WASTE71RE <br /> UNDUMOUNDTANK(MOtaTORINGIREMDYAL) 0DOG KENNEL 0DAIRY . <br /> HAZARDOUS WAM GENERATOR O CHICKEN RANCH ❑WASTEWATER TNEATNENT PLANT <br /> O TIERED PERMITTED FACILITY [3 MOTEL/HOTEL 0 PUAPERTRUGK/YARD/CHEN TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLIQATION SITES <br /> 13 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Renew. MONDAY-Emmy 8:00 AM6:OOPM - EXCLUDING HOLIDAYS. <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 naw <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 /> troae.aaooe <br /> +H4Ms <br />