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VJ/CJ/LVVI II io rmr,"4 �/ 1&002/002 <br /> 11 r V � PTvCO�x1NT Y� w_ n rw� o <br /> SAN J'O ,Q EHD LOG NUMBER <br /> FJ"RONMEN A-t-HEALT11 MPART)NENT <br /> 1- [440 2 5 East Weber Avenue; 3rd Ttoor, Stockton, CA 95202-270id <br /> If—C Telephone:(209)465-3420 FAX: (209)464-0138 Web;www4gov-org <br /> �' - ENVIRQNMENT HEALTH �J <br /> PERMIT/SERTMMLIC RECORDS RELEASE "PLICATION <br /> APPLICANT: Of 11 r. <br /> Ier�ADDRESS; ZBZS /V) ff.,�fe �C.0 BUSINESS/AGENCY: <br /> PHONE(1): 7 y8-137 . PHONE(,Zj: <br /> FACSIMILE: x' ( <br /> TENTATIVE`APPO)NTMENTDATE; S P <br /> (Please a0ow 10 LKM;r,eae da from Ttme: <br /> ri date of application sub nnW-1•-F4nf20"Only-must CC�rmled) <br /> q CHECK BOX to CXPEDITE ftEQU 855.00 FEE(CASH OR CHECK ONLY)-REQUESY PROCESSED W 3 BU WESS DAYS <br /> SIGNATURE OFAPPLICA14T DATE �Z b <br /> Electronic Informatlon: ❑ LisF Map Deserlption: <br /> . 1 <br /> ADDRESS EHD USE ONLY <br /> IElStreet it street Name city <br /> I/a YG ONWlAST OLp� Vnit1GIZ J _ Urlm 2 <br /> 3. <br /> 4. unit 3 <br /> 5. <br /> 6- Unit4 <br /> 7. <br /> $, ❑ Unit S <br /> 9. <br /> ❑ unita <br /> Specific Date Range of Information Roquested:From to 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ;VUNDlRDROIMa TANK(UST)CLEANUP SITE(LOP) P Howima ABArFmENT 0 Soup WA3Te FACUTYNEACLe <br /> ,PTHER CLEANUP Sre(NdH-LOP) DDOD FACILrrT o W <br /> TIRE❑ oc KENNELoeRetauNo TANK(aoHlroWrw <br /> J4WSARW08 WASTE(39NERArOR t3 CHICKEK RANCIt 11DaIRm <br /> Q TRb PERNTD FACILITY WASTEWATER TREATMENT PUr ' <br /> 7 TEL <br /> 13 0 PVMPERTRUCKr(AROICH[YTOILETS <br /> TATTOWBODY PIERCIND - El POWSPASC APPLICATION SmES <br /> ❑MEDICALWAsreFACILITY K TIIER(PLEASESPEWY�L uf/21' <br /> WELL AND SEFMC PERMIT RECORDS ARE AVAKMLE rOR REVIEW . MoNDAy pAVAY 9:00 AM.S:ODPM • EXCLUDING HOLIDAYS. <br /> I. List up to ten addresses in the space above, Select the type(S)of files from the list abova by checking the appropriate <br /> box(es). At least one file type MUST be selected. FM 1912091 484.0 38 or m9 1 to the address Indicated above Address <br /> ranges will not be accepted–for additional assistance with file addressas,contact the EHD.Applications received after <br /> 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 approximately tan(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 now application may be 00 <br /> submitted when tho file Is available, <br /> 4. Any filo not returned in the same condition as released will be reorganized by EHD staff at the ekpense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review., <br /> EHD USF ONLY <br /> (o — �Vv <br /> ell {6d6 iyjOW <br />