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DAT I E (���(� � R1, <br /> U E� �[DSANJOAQUINCOUNTYr <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC 0 7 2006 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION ' _ <br /> APPLICANT: S BUSINESSlAGENCY: Y-1 Le_ tS ; /ci�D,W <br /> ADDRESS: fjjQU_)&,r <br /> 6 !r� <br /> PHONE(1): Y f. �oZaZ$_S_V6 y PHONE(2): ��J�` o��Sr~/.��/(JD —FACSIMILE: 71 J���S— <br /> TENTATIVE`APPOINTMENT DATE: l"-kI Z t 0 Time: / - oJ�17�) <br /> Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU ST-$95.00 F (CASH OR CHECK ON REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 6DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS _EHD USE ONLY <br /> --street# Street Name TCity ❑ Unit 1 <br /> S4-o c <br /> z. may/� LJ�• b2,(I'- I. <br /> 7 lel V LLe lC UnR 2 <br /> G ^ J r Unit 3 <br /> a. 1 q s . (�;n(_o!1 S , - V <br /> 5. �7 Q-)e'10ejC St. Unit4 <br /> 6. mc&An s1�__. <br /> 7. L� ., ryjo-n ST' ❑ Unit 5 <br /> 8. / l.� LAr t,_t: +• G L )C . <br /> 9 J!r.F <br /> Unit 6 <br /> 10. F <br /> Specific Date Range of Information Requested:From C.IjJ- - to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> M+ DERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATrzmENT Ct'!SDUD WASTE FACILITYIVEHICLE <br /> �ER CLEANUP SITE(NON-LOP) 17 FOOD FACILITY WASTE TIRE <br /> ERGROUND TANK(MONITORINGIREMOVAL) E3 DOG KENNEL Q DAIRY <br /> RDOUS WASTE GENERATOR El CHICKEN RANCHWASTEWATER TREATMENT PLANT <br /> TIERED PERmiTTED FACILITY ❑MOTELIHOTELP PER TRUCKIYARD/CHEM TOILETS <br /> O TATTOOIBODY PIERCING POOLISPA �LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - ExCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address indicated above, Address <br /> ranges will not be accepted-for additional assistance with file addresses,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 ten(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 new application may be <br /> 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 expense of the applicant <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> -v(o hok 6nv" ion46 <br /> EKE)4" 9t1 312M <br /> TOOU ddV2LL SIMTJ NIAAOD DHV9 05f9 999 STV YVd 90:ZT 90OZ/LO/ZT <br />