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04242009 12:56 SIERRA DELTA CONSULTANTS LLC � 12094640139 N0.955 D01 <br /> F LUJ <br /> IIAT <br /> REHO LOG NUMBER <br /> f1 ��E� /c/ SAN W v ENVIRONMENTAL HEALTH DEPARTMENT 07 <br /> `J 2 4 2009 304 bast Weber Avenue, 3`1 Floor, Stockton, CA 95202-270 ux <br /> v Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.urg <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/ <br /> APPLICANT: BUSINESSIAGENCY: Sly <br /> ApORE85: <br /> PHONE(1): � '1 <br /> S• 23j-I' 4-K2 PHONE(2): FACSIMILE: ' awl- 130 1 <br /> ,-g(��o <br /> TENTATIVE'APPOINTMENT DATE' Time: <br /> (Please allow Ill business days from Bete of application a,,bmat I-'Tantattva only-must he confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$03.00 FE ASH O/gGvH�ECK ONLY).REQUEST PROCESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l-.O.ti�S 0.'eow DATE 4, 2+ <br /> UNIT DISTRIBUTION ❑ Unit 1 0 Unit 2 13 Unit 3 ❑ Unit 4 C3 OAR 5 Q Una 0 ❑ Other(elacnanlcllists/mapa) <br /> FILE ADDRESS EHD USE ONLY <br /> SdaotM Sheet Name <br /> 2. tls <br /> a <br /> 3. <br /> 6. — <br /> T. <br /> a. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: from to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q HDUSINGADATEMENT 0 SOLID WASTE FACILITTNEHICLE <br /> �4 UNDERGROUND TANK(UST)CLEANUP SITP(LOP) C FOOD FACILITY ❑WAsTE TIRE <br /> 121T ER CLEANUP SITE[NON-LDP) 13 DOG KENNEL DDAIRY <br /> UNDERGROUNa TANK(MONITORING!REMOVAL) CI GMIGNFN RANCH ❑WASTEWATER TREATMENT PLANT <br /> �'HATAKDOUS WASTE GENERATOR ❑MOTEtIHOTlL 11 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TIEKED PERMInuo FACILITY ❑LAND USE APPLICATOR SITES <br /> TATTDGIEODY PIERCING 13PDOLISPA <br /> 0 MEGICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW � MONDAY-FRIDAY 8:00 AM-5.00PM - EXCLUDING HOLIDAYS. <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 ono file type MUST be selected. Fax a f209)464A138 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 appointmentfor 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 /> cND aenaau <br /> 11tY0a <br />