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DAl'�Fd�&IVE6� � \V/ ED V END LOG NUMBER <br />11 U�FCl� J�JJII� �UUU l/ III��� SAN JOAQT.TIN COUNTY <br />NOV 2 0 2006 ENVIRONMENTAL HE, ALTH. DEPARTMENT <br />304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br />ENVIRONMENT HEALTftholte: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/chd <br />PERMITS I'MCES ` <br />_/P-UIBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:KILf6L ��UC—LII�r/ BUSINESS/AGENCY: FT/C Fyip/`//Ci'/h9 _ <br />ADDRESS: -7.28'5 1WOr?- � ,.�iiwh/il , P/�areaf /h// , 1W 9i/$a3 - - <br />PHONE(1): �25'- 6bl-45t!/i Y* PHONE(2): IaT-JSfJ-5&36 - -FACSIMILE:�.ZS-64 <br />TENTATIVE" APPOINTMENT DATE: Ja l e H-/D(e Time: M )W <br />(Please allow 70 business days from date application submittal - "Tentadve only -must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST -$95.00 FEE (CASH OR CHECK ONLY) • REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT'a �f�(1 DATE lfso`D/� <br />Electronic information: ❑ List E] Map— Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street S <br />Street Name _ <br />City <br />❑ Unit t <br />1. <br />�/K <br />2. <br />142 <br />r <br />% ❑ Unh2 <br />S. <br />.2 5( <br />Unita <br />4. <br />5. <br />7. <br />-0' Units <br />9. <br />❑ Units <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />/.UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSINGAaATEMENT O SOLID WASTE FACIL"TVEHIGLE <br />OTHER CLEANUP SITE (NON -LOP) O FOOD FACILITY Ct WASTE TIRE <br />��UNDERGROUND TANK (MONITORING/REMOVAL) O DOG KENNEL O DAIRY <br />.15iAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br />y� TIERED PERMITTEb FACILITY C3 MOTEIIHOTEL - O PUMPER TRUCKNARDICHEM TOILETS <br />❑ TATTOOIBODY PIERCWG ❑ POOLISPA t3 LAND USE APPII,,K:ATImI SITES - <br />CIMEDICAL WASTE FACILITY O"THER(PLEASESPECIFY W0 OfMdE <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 -S:GOPM - EXCLUDING HOLIDAYS. <br />1. List up to ten addresses in the space above. Select the type(s) of flies 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 add ss indicated above. Address <br />ranges will not be accepted —for additional assistance with file addresses, contact the END. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ton (10) <br />days after receipt of application. The files will behold 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 END staff may not be immediately available for review. A new application may be <br />submitted when the file is available. <br />4. Any file snot returned in the same condition as released will be reorganized by END staff at the expense of the applicant <br />Future rile reviews by the same applicant may require a $95.00 deposit prior to review. <br />FHn USE ONLY <br />EHOO46 WISMW . <br />TO 39Vd , Hd DNI2133NI91,13 0113 OLLVZ099L6T 80:LT 9002/0Z/TT <br />