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FROM FAX N0. :. 21 2006 07:35PM P1 <br /> DATE R(jECEI . EHD LOG NUMBER <br /> R C C I"1 U� DD SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3"d Floor, Stockton,CA 95202-2708 <br /> L 2 1 L��6 Telephone:(209)468-3420 Fax: (209)464-0138 Web: wWW-Sjgovorg/eh <br /> ENVIRONMENT HEALTH PUBLi RECORDS RELEASE APPLICATION <br /> PERM /� <br /> APPLICANT: C/ B USINESS/AGENCY: G- <br /> ADOREss: �/ 1t1�lCs� �i1 ' / <br /> PHONE(1): I 7� �a PHONE(Fo� <br /> 2): S / / 01F FACSIMILE: S <br /> 1 <br /> TENTATIVE"APPOINTMENT DATE; .�" qV, I IQ b/�-• Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE T-$86. E(CASH C NLY)-REQUEST PROCESSED IN S BUS NESS D Ys <br /> SIGNATURE OF APPLICANT DATE 06 <br /> Electronic Information: ❑List[]Map-Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Street# Street Name city ❑ Unit 1 <br /> 2. CI Unit 2 <br /> 3. Ott— 01750—,5-41, S / <br /> 4. unit 9 <br /> 5. En v I R o n e — 9 <br /> Unit 4 <br /> 6 © Unit 6 \ <br /> 9. <br /> Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> k <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) C HOUSING ABATEMENT $OLID WASTE FApI.nYINEHICLE <br /> eR CLEANUP SITE(NON-I-OP) ❑FOOD FACILnY WAsTr:TIRE <br /> ERGROUND TANK(MONIToR1NG/REmovAL) ❑Doc KENNEL ❑DAIRY <br /> ARDOus WASTE GENERATOR la CHICKEN RANCH ❑WAS IFEWATER TREATMENT PLANT <br /> ❑TIEReD PERmrrrED FACILITY 13 MOTEL/HOTEL C3 PUMPERTRUCK/YARDICHEM TOIIFTS <br /> ❑TATTOo1DODY PIERCING 0 POOLISPA ❑LAND USE APPLICATION SITE8 <br /> 17 MEDICAL WASTE FAMIry 0 OTH9R(PLUSE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORD$ARE AVAILABLE FOR REYr-W- MONDAY-FFRIDAY 8:00 AMd:00PM - ExCLUDwc 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(?29)464-0138 or real 1 to th 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 CH b Vila notify the applicant if any EHO files exist An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The flies 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 revlew.'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 END staff at the expense of the applicant <br /> Future file reviews by the Game applicant may require a$96.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD" M3r1OO6 <br />