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09/29/2006 11:29 FAX � � 16002 <br /> EH6 LOG N!.iMBEF <br /> °' SAN JOAQU IN COUNTY <br /> D <br /> (o <br /> U U � ` �D EiN k,IFcONMENTAL HEALTH DEPARTMENT <br /> 304 bast Weber Avenue, 3d Floor, Stockton,CA 95202-27 <br /> E <br /> SEP 2 9X006 08 <br /> Tel Fax:(209)464-0138 Web: www.s}gov.OT9/eh 2 J <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICA'T'ION _ _- <br /> PE-RMlT1 �E$= 1W <br /> , -- <br /> A �L:CSN BUSINESWAGENCY: alla-a.• k.z:tT� d' SSet ._. <br /> ADDRESS: `'34PiJ W N vexed Il a_ Face. �'e m`ro�as axon --- <br /> PHONEitr:�rZaj1A 23q-77ZZ PHONE 12): ( f&) cX7T -7f5f __---FACSIMILE:_aall2_3N- 77Z <br /> TENTATIVE`gFFOiNTMENT DATE: <br /> (Please si:ow ,e businesE days from data of application submittal•"Tentative only-must be eontinr4d) <br /> (;!-.ICK BOX TO EXPEDITE R yW, T 493.OG FE, (CP$k(OR ECK ONLY)-REQUEST PROCESSED IN 3 EUSINEa3 DAYS <br /> `- 1OL/�-rF(j I ' <br /> SIGNATURE OF APPLICANT � [-� k DATE 9 2`1 <br /> aJH:?DtSTRieUlipN j', C.Unit, 0Unk2 CUnit3 CUnft4 CUnit5 C Units Cl Otber(e'ectronieliisteJmapa) <br /> fiLE ADDRESS _ EHD USE ON <br /> �r Street Noma SHY— <br /> 'Ll <br /> HY' 1 - <br /> _y�l I�tAerL'TiiuR 't�a<y -- <br /> 3 s7x �t +lr.uAlE -- Tr — w5 a <br /> 4. 7I' .. efllq UAFE.. -fl. <br /> AlE. <br /> E'I,tS Loc: .-405 Vj <br /> 4I TTfa <br /> { s 1 r- I l) i I41A .F .r .. ✓ ..LCRnC�1 3 .®. _ <br /> t•=. T5o:r <br /> asa.. <br /> 1 -77-77 tjTM1 g..T V.1 .. _Stacy ._ —_._ _ . .. <br /> S 1 EVE 3IH ST Truce <br /> Spee fic€rate Range of information Raquested:From _ <br /> ENVIRONMENTAL HEALTH DEPART <br /> YyUNDERGRU?AD TANK(U$0 CLEANuv$rIF ILOP) 0HOUSING ABATEM SouDWASTE Fmim yNEH LE <br /> OTHER CLEANUP SITE(NON-40P) 'C FOOD FACILITY 12 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) G DOG KENNEL C DAIRY <br /> 5HAZARDOUS WASTE GENERATOR CCHICKEN RANCH C WASTEWATEP.TREAT69ENY PLANT <br /> "':EKED PERMITTED FACILITY 0MOTELIHOTEL C PUMPER TRUDK/YARD(CHEM TOILETS <br /> M?ATTO0!BODY PIERCING 6 POOUSPA C LAND USE APPLICATION SITES <br /> L MEDICAL-WASTE FACILITY C OTHER(PLEASE SPECIFY) <br /> WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE rOR RENEW- MONDAY-FRIDAY 9:00 AM-WOOPM - EXCLU!T.NG 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 one file type MUST be selected. Fax to (209)484-0138 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 THDvvtii notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> apprc:3mateiy ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> T revie,,•+. i'-ppcintmsrts 11auld be scheduled accordingly. <br /> 'i, A fiils r. ar,is aiAlmy being "onmo on by EHD staff may not be Immedlatoly available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any fie not returned in the same condition as released will be reorganized by EMD staff at the expense of the <br /> applicant. (Future fits reviews by the same applicant may require a$93.00 deposit prior to review. <br /> I <br /> I _ _ <br /> - v±aaz.oac <br /> 5:�4)i <br />