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02/13/2006 16:23 510-4376 PSI INC ' PAGE 01/01 <br /> HP% "17-1 D SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> FEB 1 3 2006 ENVIRONA ENTALIIEALTHDEPARTWNT <br /> 304 East Weber Avenue,3 Floor, Stockton,CA 95202-2708 <br /> ENVIRONMENT HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/chd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: M!' 91wis"l. �is� & „-_-BUSINESWAGENCY: . PS.X f ;fw,.- <br /> ADOREss: 4702 Tot41wa4kr- I ;+� A f &W�1 eA 41(001 <br /> PHONE(t): f0-tj3Y-9741;0 is 17 PHONE(2): FAcsIMILE; <br /> TENTATIVE*APPOINTMENT DATE: I�Z?f'/b Time; itporL <br /> (Please allow W bus..days from date of a plkation submittal-"Tentative only-must be Confined) <br /> im CHECK BOX TO EXPED(TE REQUEST 493.00 Ertl LLOR CHE ONLY)-REQUEST PROCESSED IN 3 BUS IES-DAYS <br /> SIGNATURE OF APPLICANT /vC/z ��i!'! �� DATE <br /> z <br /> UNIT DISTRIBUTION F 0 Unit 1 0 Untt 2 ❑ UnR 3 0 Unit 4 ❑ Unit a O Unita t7 Other(eleutrordcfllarsmreps) <br /> FILE ADDRESS <br /> sagas street Name city EHD USE ONLY <br /> 2. owf- S 57 <br /> 3. 5D fsn <br /> 4. <br /> S. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested ro to <br /> eeee��II <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1Z UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSINGABATEAIENT A SOLID WAsM FACILR WrjHCI.E <br /> 0 OTHER CLEANUP SITE(NowLOP) OFOOD FACIUTT 0WASTETIRE <br /> UNDERGROUND TANK(MONrromwfREM AL) 0 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKENRANCH ❑WASTEWATER TwATMENT PLANT <br /> O TIERED PERMRiED FAciLRY ❑MOTEL/HOTEL C3 PUMPER TRUCK/YAROICHEm TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOL/SPA E LAND USE APrLICAnON SITES <br /> ❑MEDICALWASTE FACILrrf ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FMoAY6:00AM-5:00PM - EXCLUDING HOLIDAYa. <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. 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 be immediately available for review. A new <br /> application may be submitted when the fife 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 /> EHP4&a2-006 <br /> RN4Ms <br />