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10/27/2005 12:33 FAX 1 209 234 7727 STOCKTON U001 <br /> 2005 13:17 46401: ENVIRONMENTAL 1 LTH PACE <br /> SAN JoAQulrt CouNTy <br /> '-PMRONMENTAL Y-UALTIi DrPARTMENT 304 East Weber Aveliue, 3n°Floor, Stockton,CA.95202-2708 20403 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www sjgov.or g%hd <br /> = PUBLIC RECORDS I2RLE ASE APPLICATION 2005 OCT 27 PM 2;23 <br /> APPLICANT; U BUSIHFSSIAGENCY: x{211 <br /> I AabaESs: HEALTH OF MEfdTAL <br /> 1.} PHO N6(I): fs.1LQ. �-Z-(yay <br /> PHONE(2): 234- ��22 X3ZIr}FACSINILE: ZoPA <br /> - �- <br /> TENTATIYE'APPOINTMENTDATE Time: <br /> e <br /> (Please allow 10 birslners <br /> days Gam date of application submvw--renteve only-must be confi <br /> U CHFCK BOX TO EXPEDITE RE ES $93.00 FEE(GOSH rat O��_REQUEST PROCESSED tN a BUSINESS DAYS <br /> ;:4A.TURE OF APPLICANT 'ADATE IO p ` - va <br /> _ -�T:)1S7RlBUT1pN a UNt7 Udt�fO Unn6 Q UnN6 l7 Other(eleckonlcAistshnap5l <br /> Suet s y et Homo CR EHD USE ONLY <br /> 1. 13 <br /> 2 � <br /> 3• <br /> 4, rJ Qy <br /> 6. <br /> 9. <br /> 10. <br /> -fic Date Rango of Information Requested:From to <br /> - ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> y-vADWOR"b TANK(UST)OLLAmP W E(LOP) I7 tteu"K;A;ATEUMT O SOM WASTE FACKMMEMO E <br /> \ -(pt•tinier.CLE44M Sm(Non.LOP) 0 Food FACILITY D WASTE Tate <br /> y-�UNAEP,O ROWD TAW(MOtLTORrtM F&WAL) 0Do2 KENNEL ODAatT <br /> JdHAZAPDOUSWASTE OERERATOR tlQr����pl,'r&J�r�RANCH EJWAsTEWATwT�Ta6xrPLANT <br /> M T�EFtD PERutmo FAcxnT fy M�O�1EyA��10M E3UMP <br /> PER TRtXWYAAD1CHGM TOILETS <br /> M TAMCMM PIERCMO. 'O POMJrPA L3 LANo USE APPUGAT10N SITES <br /> j O Mrm:AL WAS TE FACUTY - ❑DtMER(PLFASE SPEnr� _ -- <br /> WELL Am SEPTIC PEwaT REcoROs ARE AYAILABLE Pat Rvmw- MotmAy rpmAr a.0o A -9:Q0Pa - EXCLUDMHOLMM- <br /> i . <br /> t up to ton addresses in the space above. Select the,type(s)of fibs from the list above by checking the <br /> propNate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address <br /> .iiczted above. Address ranges will not be accepted-for additional assistance with file addresses, contact <br /> e EHD.Applications received after 3:00 pm will be processed the next business day: <br /> EHD will notify the applicant If any EHD files exist An appointment for review will be confirmed <br /> ox(mately ton(10)days after receipt of application. The files will bo held for a maximum of five buslnes <br /> -r s for review. Appointrhents should be scheduled accordingly. <br /> :. :i <br />