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02/13/2006 16;23 510-476 PSI INC PAGE 01/01 <br /> ffik D SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> FEB 1 3 2006 ENYmommNTAL HEALT.0 DEPARTMENT <br /> 304 keast Weber Avenue, .-( 09)4 Stockton,CA.95202-2708 <br /> ENVIRONMENT HEALTH Telephone:(209)468-3020 Fax:(209)464-0138 Web: wwwsjgov.orpfehd <br /> PERM!T/SERVICES <br /> pQ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Mr. lJfr6K. S�n�ck.. BUSINESS/AGENCY: Sr . wf- c. <br /> ADDRESS: VQ'% C4a wa{c>~ l�p �. �G / a;��t e 5 ycool <br /> PHONE 17,00 x l7 PHONE(2): <br /> FACSIMILE: 7( <br /> TENTATIVE'APPOINTMENT DATE: y b Tim; awn <br /> (Please allow 10 businasa days from date.�Dta <br /> t plI61190n submiaal- Tentabw only-must be COnffmmd) <br /> CHECK BOX TO EXPEDRE REQUEST-S93.00LU (CA"CHE ONLY)-REQUEST PROCESSED IN 3 BUS�ESSSDAAYSS <br /> SIGNATURE OF APPLICANT /�//'� �/ DATE 4 rV in v <br /> 11NrTDISTRIBUTION O UnitT EIUnh2 O UnR3 0U-h4 ❑ Unhs O Unite ❑ Other(Nectronitlnawmps) <br /> FILE ADDRESS <br /> meat# street Name City EHD USE ONLY <br /> 1. 2 f7 Qo3�C IF/ock-#ax fflv <br /> 2. on# 5 Sy, 7- <br /> 3. <br /> 3. 5D fsn <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 8. <br /> 10. <br /> Specific Date Range of information Requestad , ro to <br /> e� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M UNDERGROUND TANK(UST)CLEANUP SME(LOP) ❑HODSINGAGAIE NT ❑SOLIDWASTE FACILITYIVMCLE <br /> 01 OTHER CLEANUP 9nE(N0N-L0P) ❑FOOD FAc1uTT 0WASTE TRE <br /> UNOERG tomo TANK(MONIToR:wtREMOYAL) ❑DOG KENNEL d DAIRY <br /> HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH ❑WAVEWATER TREATMENT PLANT <br /> O TIERED PERMrTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDMHEM TOILETS <br /> TATTOOIBODY PIERCING d POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILrIY O OTHER(PLEASE SPMFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY.FmDAY 8:00 Am-5:00PM - EXCLUDING HOUDA". <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. EW 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 /> S. 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 /> Eno AA.ozaae <br /> +nsn: <br />