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02/13/2006 16:23 510-43676 PSI INC PAGE 01/01 <br /> W <br /> n G,.��..`� 4_ SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �1� <br /> FEB ? 2006 ENV)RONTYmNTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,Yd Floor,Stockton,CA 95202-2708 <br /> ENVIRONMEfI( HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.o4chd 7. 1 q3 <br /> PERNIMSERVICES pp ELIC RECORDS RELEASE APPLICATION <br /> U <br /> APPLICANT: N(-. 17184t. Swzck-. BUSINESWAGENCY: - <br /> ADDRESS: X70 t n*A4akr— %T& 13 .. C&aG�f eA IY(ool <br /> PHONE(1): x 17 PHONE(2): FACSIMBF:p/r�5?D—rfS-'y-'7GT <br /> TENTATIVE*APPOINTMENT DATE: y Ry/a!o Ttme: &II-1001t <br /> (Please allow 10 business days from date Of a pikaUen submitral-"Tentative only-must be Confirmed) <br /> M(/CHECK BOX TO EXPEDITE REQUEST-$93.00 E( CHE ONLY)-REQUEST PROCESSED IN 3 BUS ES a DAYS <br /> SIGNATURE OF APPLICANT DATE t7 <br /> UNrr DISTRIBUTON 0 Unit 0 Untt2 I=Units EJUnit4 M Unha ❑ Unite E3 Other(clmtronkttlstannaps) <br /> FILE ADDRESS EHD USE ONLY <br /> street* Strut Name city <br /> �. -2.0 N. 4.1.z 01ba_I10'+n- <br /> 2. 1 4IC70 S Sia 7 <br /> 3. 15D cG i s <br /> 4 <br /> 5. <br /> 6. <br /> 7. <br /> 8. om Ina <br /> 8. <br /> % <br /> Specific Date Range of Information Requested Uro to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> MUNmE Roma TANK(UST)CLEANUPSME(LOP) O HOUSINGA9ATE1AENr O SOUDWASTB FACILDYAJe4mc <br /> 0 OTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY 0 WASTETRE <br /> UNDERGROUND TANK(MONnORING/P.EATOYAL) 0DOG KENNEL 0DAIRY <br /> HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUFFER TRUCK(YARDICHEM Tciun <br /> 0 TATTOO/BODY PIERCING ❑POOUSFA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE rACILRY 0 OTHER(PLEASE SPMM <br /> wELL AND SEPMC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOUDAYs. <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)464-0138 or mail 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 /> troae.ozaoa <br /> �it4fas <br />