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18/2006 10:59 FAX IM002/002 <br /> DATE RECOVEO SAN JOAQCOUNTY EHD LOG NUMBER <br /> '� '" "E4NMONMENTAL HEALTH DEPARTMENT <br /> JAN 1 " / ' East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> TC . oue: (209)468-3420 Fu: (209)464-0138 Web:www_sjgov.org/ehd <br /> ENVIRONMENT HEALTH <br /> KBIVIITISERVIMUBLIC RECORD_ S RELEASE APPLICATION _ <br /> APPLICANT:_ ^lAP5 J- &COSI O S BUSINESSIAGENCY: 'k't <br /> ADDRESS:,� Z8"Zl� CITY__STOCfi`~�Ct"�/ STATE,, <br /> PHONE(11XAF�t� �`t�' 13`IS' PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE:—_Z I. Ab(o Time: i Z _ <br /> (Please allow 10 business days from date of application submittal-`Twfativo only-mast be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REGU T-393.00 FEE( SH OR CHECK ONLY)-REQUEST PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATEl V oILi <br /> Informstton — <br /> Electronic ❑ List C3Map-Deacrfption <br /> FILE ADDRESS EHD USE ONLY <br /> Strati Street Name CITy <br /> 1' P' UZUnit <br /> Unit 1 <br /> z. c_ I 3• I Unit 24s. Unit 3 <br /> 6. <br /> 7• Unit 4Unit 5 <br /> 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> hl UNDERGROUND TANK[UST)CLEANUP SITE(LOP) ❑HOUSNO ASATEMFA7 IS SOLID WASTE FACILRYIVENICLE <br /> t S.OTHER CLEANUP SITE(NON-LOP) ❑FOOD FAca Try ❑WASTE TIRE <br /> IKUNDERGROUND TANK(MOWTORINGIREMDYAL) ❑DOG KENNEL `!�7,,DAIRY <br /> 09 HAZARDOUS WASTE GENERATON 13 CHICKEN RANCH "ASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑MwELIHOTEL ❑PUMPER TRUCKIYARDICREMICAL ToLcTs <br /> ❑TATTOOIBODYPIERCMG 0PODUSPA ALAND USE APPL TmN Sms <br /> O MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILARLE FOR RE iEw-MONDAY•FRIDAY e:oo AM-&GOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checlIng the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the zlddress <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 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 expf,nse of the <br /> applicant Future file reviews by the same applicant may require a$93.09 deposit prior to review. <br /> END uu <br /> 10T]1R00T <br />