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06/03/2005 10:00 916-371W <br /> 16-37 09 RANEY GEOTECHNI PAGE 02/0' <br /> n <br /> (� D ��� G NUMBER <br /> L CtW ED SAN JOA,QUIN COUNTY '^v'3' h K <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN. 0 0 7005 304 East Weber Avenue,3'd Floor,Stockton,CA 95202-2708 <br /> ENVIP,�3N9 fNT HEALTH Telephone:(209)468-3420 Fax:(209)40-0138 Web:www.sjgov.oTg/chd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY:�j � <br /> ADDRESS: ® c .� a W "� ��G. w�- <br /> PHONE(1): PHONE M: <br /> TENTATIVE*APPOINTMENT DATE. 1 -7"s rrrNe: ®tel_ca a <br /> TM <br /> (Please allow 10 business days from jate 6f atppllcation submittal-•Tented+,*only-must be rmad) <br /> CHECK BOX To EXPEDI'm R7=Q sT 593.00 FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 8 BUS NESS DAYS% <br /> SIGNATURE OF APPLICANT DATE® <br /> umrr DISTRIBUTION 0 Unit 1 ® U nK H 4 0>anit 5 unit B © Other(electroMGllsts/maps) <br /> FILE ADp END USE ONLY <br /> Street S Sheet Name ( Cny _...-- <br /> 1._—'2.211... __��_t�, r�1nJ�—L�i-�•��pa^:_.. .usT .. <br /> .......... <br /> ,,v ' %"4 6. 14 3-Z- � D �o� its r• W -- <br /> 10. > UN.a.:� 005. kmm lisp, <br /> Specific Date Range of Information Requested:From to <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILESa lid <br /> ufl <br /> PEROROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUM6 ADATEMENT olds WAM FACKMIvRNICt.E <br /> uER CLEANUP SITE(NON-LOP) ❑Foob FACE.rIY WASPe TIRE <br /> DERGROUND TANK(MOmmRINedREMOVAL) 0 Doe KENNEL ®DAIRY <br /> !ErRDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑WASTEWATER TREATNIIIN9 pIANT <br /> 19 TIERED PERMD9'W FACHM 0 MOTELIHOTEL 0 PUMPER TRIJOWYARDICHEM TOM41 <br /> 0 TATTdOMODY PMRCINO 0 PvoUSPA 0 LAND USE APPLK AnoN Srttis <br /> 0 MEm wki.WA=FAcs r" 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAn Am a FOR REVIEW-#A0NDAV4FvuDAV 8:09 AM-S:MM - EXCLUDING HOLIDAY*. <br /> 1. List up to ten addresses In the space above. Select the type(a)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to L:09)4640138 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 END will notify the applicant If any END flies 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 tA <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by END staff may not be Immediately available for review. A now <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 END 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 /> RV <br /> fs11D Aa-02-0oe <br /> 1/tlf95 <br />