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209.66.7-9668 p•1 <br /> Jan 29 U f i m i a Apex <br /> EHOLOG NUMBER <br /> SAN JOAQU N COU' N-TTY <br /> JAN 2. 9 2007 ENVIRONMENTAL HEALTH(DEPARTMENT <br /> ENVIRONMENT HEALTH 304 East.Wcber Avenue,3`d Floor, Stockton,CA 95202-2708 <br /> 07 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web: www.sjgoV-orglebd <br /> PERMIT/SERVICES . <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> pp ' <br /> APPLICANT: Qrew cxvx L BUsiNESSIAGENCY: <br /> ADDRESS: 3`-l�t� �'I`A'`n �{c, yluJ. :SU►3-e G '�„r(-acK. C4 't576? <br /> PRONE(1): Z`a [ PHONE(2): ZC�`t � - 2 t'S Z _ ACSINULE <br /> TENTATIVE"APPOINTMENT DATE: F-4' Time: d/ <br /> (Please attow 10 business days from date of application submittal-•Tentairve only-must be iroeftrmed) <br /> ❑ CHECK BOXTO F-XPEDITE RE���,93.00 FEE CASH OR CHECK ONLY)-REQUEST PRODCA�D IN 2 U E5S DAYS <br /> SIGNATURE OF APPLICANT VV r Zeta <br /> UNrr DISTRIBUTION C❑Unit 1 r3 Unit 2 ❑ Unft 3• ❑Unit 4 CI Unit 3 0 Unit 6 0 Other(elec ronicilistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name Citi' <br /> 3_ qZHQ <br /> 4. <br /> 6. ' <br /> 7. <br /> i o. <br /> Specific Date Range of Information Requested: From N'��`='`f to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X/UNDERGRDUND TANK(UST)CL.eANIiP$ITE(LOP) <br /> 0 Hous No AeAMMENT 13 SOLID WASTE FACILITYNEMOU <br /> 0 OTHER CLEANUP SITE(INION-LOP) Q FooD FAaLfTY i3 WASTE TIRE <br /> 13 UNDERGROUND TANK(MONrfMWdREMQVAL) 0 nou Krumm 13 DAIRY <br /> 0 HAZA moos WAsre GENERATOR 13 CHICKEN!RANCH IO WASTEWATER TW-ATMSNT PLANT <br /> 13 TIERED PERMITTM FACILITY 10 MOTEL/HOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑TATTOWBODY PIERCING 0 POOLISPA E3 LAND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FACILITY 17 OTHER(PLEASE SPEC" <br /> YIfELLANO SEPTIC PERMrf RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY S:00 AM-5:00PM - ExcLumNG 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 boxes), 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,can'tact• <br /> the EHO.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 /> t 3. A file that is actively being worked on by THD staff may hot-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 priorto review. <br /> EH D 4"2401 <br /> € V14M <br /> l <br />