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02/13/2006 1G:23 510-40G7G PSI INC PAGE 01/01 <br /> nIII1- WW LLQ EHD LOG NUMBER�U(�L��- SAN JoAQYrzN COUNTY <br /> ENVRtONWNTAL HEAJ�TD AEPARTM)ENT ///��� <br /> FEB 1. 3 2006 304 Fast Weber Avenue,3 d Floor,Stockton,CA 95202-2708 <br /> ENVIRONMENT HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjsov.org/ehd L I q3 <br /> PERMfgSERVICES p PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: M!' 86Taal. BUSiNESSIAGENCY: '-- <br /> ADDRESS: y 7o 2 7'otz,_4a{cr &L� 13 C7a�� .c f eA I I k9l <br /> PHONE(1): S`[O-y7r(-gy7U x 17 PHONE(Z): FACsiMiLE:/�/^,�/?D-D! -'7676 <br /> TENTATIVE"APPOINTMENT DATE: y r l'�069 Time: &II-Rapn <br /> J/ (Please allow 10 businoss days from date of a pilcatlon submittal-"Tentative Only-must be confinnod) <br /> D0 CHECK BOX TO EXPEDITE REQUEST-$93.00 E( CHE ONLY)-REQUEST PROCESSED IN 3 BUSLNESS DAYS <br /> SIGNATURE OF APPLICANT /I y� DATE W o e <br /> UNIT DISTRIBUTION 0 Unit o Unn2 O UnhE O Unh4 O Unh6 O UnitB l3 Other(dectrcnicil sRnaps) <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name City <br /> 43.cC <br /> 2. a...f- S 577 7' <br /> 3. 5-D f°^ <br /> 4. <br /> S. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested ro —M <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )Z UNDERGROUND TANK(UST)CLEANUP SMS(LOP) 0 HousINGARATUMENT C3 SOLIDWASTE FACILRYAt"dLe <br /> to OTHER CLEANUP SII•E(NON-LOP) R FOOD FACILITY b WASTt'nRE <br /> UNDERGROUND TANK(M0WQ"NGtREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR 13CHICKEN RANCH ❑WASTEWATER TREATmeNT PLANT <br /> O TIERED PERmrnED FACILITY O MOTEL/HOTEL O PUAPER TRUCKlYAROfCHEM TOILET$ <br /> 13 TATTOOIBODY PIERCING 0 PCOLISPA ❑LAND USE APmTOATION SrTEs <br /> ❑MEDICAL WASTE FAciuTI• 0 OTHER(PLEABE SPE" <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RAvIEw- MONDAY-FmoAY 8:00 AAI-5:OOPM - EXCLUDING HOLJOAYS. <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 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 appilcation. 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 /> 0. <br /> �--•3A Y <br /> EHD 48d2-0U6 <br /> t114A1s <br />