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May. 18. 2006 9:52PM Advanced GeoEnvironmental No. 4936 P. 2 <br /> DATE <br /> RECEIVEDD CHID LOG NUMBER <br /> WECHvEP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W 1 [006 Tele304 East Weber Avenue,3 a Floor, Stockton, CA 95202-2708 4/�0/)� 07 / <br /> phone: (209)468-3420 Fax: (209)464-0138 Web:ww W.sjgov.org(ehdL <br /> ENVIRONNIEN I HEALTH PUBLIC RECORDS RELEASE APPLICATION J <br /> 7ADDRESS: <br /> NT: U h Gil SUSINESSIAGENCY: 1) A fU S �(� S'`�'O `' Cq/ <br /> PHONE(1): aD / ' 7� ! 'ID�� PHONE(2): O��AD-7. ' 'Zhc — e2A(7 fC FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE:,'y a )kL? 'ZO&,.,-, Time: 1G)-00A0k _ <br /> (Plaeae allow 10 business days from 11110 of 2,iollcaflon SUbm"al-'rentadve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE E T-$93.00 FEE(CA CH K ONLY).REQUEST PROCEgSED IN 3 eUSIN $$DAYS <br /> SIGNATURE OF APPLICANT f/k�Q- _— DATE Jr <br /> UNIT DISTRIBUTION ❑ Unit1 unit2 O Unita ❑ Unit ❑ Unita 0 Unite ❑ Other(electronleAIs%ImafM) <br /> FILE ADDRESS END USE ONLY <br /> Street s Street Name City <br /> t• a i u <br /> z. PS'-' Ltj <br /> 3. ! a tr tr <br /> Y- 4. �c <br /> 5. u e C <br /> a. ;.W <br /> nowC <br /> e. rn l <br /> 9. <br /> 10. <br /> 4,SA <br /> Specific Data Range Of.infotmation Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> fu <br /> NDERGROUND TANK(UST)CLEANUP$ITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILTYNEIOCLE <br /> THER CL ❑EANUP BITE(NON-LOP) FOOD FACILITY ❑WASTETIRE <br /> NDERGROUND TANK(MONITORINO/REMOVAL) ❑DOG KERNEL ❑ DAIRY <br /> PZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOO/BODY PirRGNO 0 POOUSPA LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERLDT RECORDS ARE AVAILABLE FOR REVIEW• MONDAY-FRIDAY9:00AN- :OOPM - EXCLUDINOHOLIOAYS <br /> 1. List up to ten addresses in the space above. Select the type(s)of Ries from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)454-0138 or mail to the acklms <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact. <br /> the END.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END fifes exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> y� <br /> END"42-M <br /> 1114M <br />