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04/18/2007 11:17 51 8340' 2 PAUL H KING PAGE 02/02 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOA.QUIN COUNTY <br /> ]ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 mast Weber Avenue, 3r1 Floor, Stockton. CA 95202-2708 <br /> T'elep one: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd70 <br /> P BL1C RECORDS RELEASE APPUCA.TION � <br /> BUSIN=ESSIAGNZ;Y�::�t�(:ft� ' C <br /> APPLICANT:AbDRESS_ <br /> PHONE(2): FACSIMILE: V�s <br /> PHONE(1): <br /> TENTATIVEAPPOINTMENT DATE: <br /> 1 f )-1," S`I $ Time: f b o r 11 1Q rel <br /> (Please allow <br /> 1 business daya from date of application aubmlttal-'Tontntive only•must bo confirmed) <br /> ❑ CHECK BOX TO EXPED TE REQUEST-$95.0 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF ApPLICAN r �-)" r'Llei, DATE, <br /> Electronic Information: List[l Map--Description: <br /> FILE ADDRESS _ _ EHD USE ONLY <br /> .. - <br /> Sheet# Street Name_ __- — Clty /�5T IQn� PCf7" unit1 <br /> \/ / 1. 2 S, r Q c <br /> �/ ---- — ❑ Unit 2 <br /> 2. <br /> 3. !p U) S c t� �-#-s A-v I- S 1-e�nXN - L <br /> _—... Unit 3 <br /> 4. swift <br /> 5... --- -- - ---- — -- �— /Unit4 <br /> 7. -— - ❑ Unit 5 <br /> 9. — - ---.. _. -- ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From A-q to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> fI UNDERGROUND TANK(UST)CLEP NUP SITE(LOP) In HOUSING A13ATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> I!�'0 HER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> 171-�NDER(3ROUND (MONITORI GIRF.MOVAL) ❑DOG KENNEL E2 DAIRY <br /> ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> M'i AZARDOUs WASTE GENERATOR 11 MOTELIHOT% ❑PUMPER TRUCKIYARDICHEAI TOILETS <br /> LlTIERED PERMITTED FACILITY in POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATT0011300Y PirmciNG <br /> 173MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PE MIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses i the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file pe MUST be selected. Fax to os 464-0138 or rpLqu to the address irldlcatedjbove.. Address <br /> ranges will not be accept d-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processec the next business day. <br /> 2. The EHD will notify the ap licant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of appli ation. The files will be held for a maxlmLlm of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively beInj I worked on by EHD staff may not be immediately available for review_ A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in th same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$99.00 deposit prior t4 review. <br /> EHD USE ONLY <br /> FI-ID41q•06 9113t2U7 <br />