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e2////1133/20r10,6/+ 16:23,. .510-4376 PSI INC itPAGE 01/01 <br /> EHD LOG NUMBER <br /> SAN JOAQU.[N COUNTY <br /> FEB 1 3 2006 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304)=sst Weber Avenue, 3`1 door, Stockton,CA 95202-2708 /� <br /> ENVIRONME(I f HEALTH Telephone:(209)468-3420 Fix:(209)464-0138 Web:www.sjgov.org/chd J <br /> PERMTSERVICES po PUBLIC RECORDS RELEASE APPLICATION <br /> a <br /> APPLICANT: M/', 144 BUSINESS/AGENCY: ar &+ - <br /> ADDRESS: Tf`70Z TCf�Wa(-cam' A+k,� ��yz' t3 I a-'4z'. .F eA 4Yt001 <br /> PHONE(1): 17 PHONE(2)z -FACSIMILE: 570-rf�4--7G7f4 <br /> TENTATIVE*APPOINTMENT DATE: Z- i5'�b[a Time: &I-ItmIt <br /> (Please allow 10 bminese dayS from data of a pllcauon submittal-"Tentative only-must be confimtad) <br /> /CHECK BOX TO EXPED(TE REQUEST-$93/.00 jE(C CHE ONLY)-REQUEST PROCESSED IN 3 BUS ESi DAYS_ <br /> SIGNATURE OF APPLICANT "A �� DATE a(�6 <br /> UNITDISTRIBUTION 0 Unit 0 Unit2 13 Unita O Unit4 Cl Unit 0 Unita 0 Other(electronIcntsffinnaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# street Name City <br /> 2. Sh T <br /> 3. SU d fen <br /> 4. <br /> 6. <br /> 6. <br /> 7. <br /> Ti III8. <br /> 9. I <br /> 10. <br /> Specific Date Range of Information Requestedro to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SnE(LOP) OHowS ABATEMENT 0 SOUDWASTE FACILrTYMEHCI1H <br /> C)OTHER CLEANUPSrM(N0N-LOP) RFOOD FACILITY 0WASTETIRE <br /> UNDUtGROMD TANK(M0Nrr0RINGtREMOVAL) ❑DOG KENNEL 0DAIRY <br /> HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH O WASTEWATER TiEATMENT PLANT <br /> 13 TIERED PERMITTED FACIUTY M MOTELRiOTEL O PLMFER TRUCK/YARD/CHEM TOILETS <br /> 13 TATTONBODY PIERCING t3 POOL/sPA 11 LAND Use APruCAT1ON SDE$ <br /> 17 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPEgFY) <br /> WELL AND SEPTIC PERMIT RECORDS AREAVAILABLE FOR REv5w- MONDAY-FmoAY 6:00 AM.5:00PM - EXCLUDING Ho1JDA". <br /> 1. List up to ten addresses In the space above. Select the type($)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 Df 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 In ew <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 /> j I�b:1 <br /> rt=e <br /> T Y-SHr�T� <br /> EHD A&021M6 <br /> U1Mas <br />