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Apr,36, 7007 8.430 PAA need Geo Environmental No.8405 P. 3 <br />DATE RECEIVEL} EHD LOG NUMBER <br />SAN Jt7A,QUXN Cdl1NT�' 6 <br />APPLICANT: <br />ENVIRONMENTAL HEALM DIEPARTMENT <br />304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ d <br />PLIC RECORDS RELEASE APPLICATION <br />t <br />aallulier`s5iIUSINESSIAGENCY: <br />ADDRESS: 0 %J'%J1 [L Vj 1 CECIL f r y ( Id •v L -f I <br />PHONE (1): /1 i/ 7 ` ( 1 d PHONE (2): O <br />FAAC!$IMILE: <br />�-� <br />TENTATIVE" APPOINTMENT DATE: <br />Tirrfa6� r <br />(please allow 10 business days from date of applio <br />ion submittal -'re tafiVe only - must be con rned) <br />CHECK BOX TO EXPEDITE UST - $`f5.00 FEE (CAH <br />HEC ONLY) - REQUE$T PROCESSED IN 3 B SINES DAYS <br />SIGH ATURE OF APPLICANT r <br />DATE <br />Electronic Information: ❑ List ❑ Map— Description;. <br />FILE ADDRESS <br />EHD USE <br />--- Street # Street Name <br />r� <br />City _..- Unit f <br />-1 — 19 orn—ron Knoet <br />46& old LkSl 91A Ceti <br />� V <br />z <br />- — <br />� <br />_ Lr.MI. k . V <br />Unit 2 <br />!Unit 3 <br />3. <br />- <br />4 -0 C) C2 <br />- _..._ .. _.- .. _. � • <br />/FIJ 1t4 <br />❑ unit 6 <br />6. <br />7. <br />❑ Unit 6 <br />Sa <br />10. <br />Specific Date Range of Information Requested: From - <br />-.. - _--- - t4 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSINa ABATEMENT M SOLID WASTE FACILITYIVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ Food FACILIrY ❑ WASTE TIRE <br />�1 UNDERGROUND TANK (MONITORING/ REMOVAL) II DOG KENNEL In DAIRY <br />HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH M WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTELIHOTEL PUMPER TRUCKIYARoICHEM TOILFT5 j <br />❑ TATTO0150VYPIERC;ING El POOL/SPA }( AND USE APPLICATION $tTE3 <br />LJ MSPCAL WASTE FACIL#TY C3 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 flies from the list above by checking the appropriate <br />box(es), At least one file type MUST be selected, Fax to (209) 464-0136 or mall 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 applicatlon. 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 atthe expense of the applicant <br />Future f;la reviews by the same applicant may require a $98.00 deposit prior to review. <br />EHD USE ONLY <br />z'jl 1 l5-7 c- LLQ <br />Lrlu 4"D 0; 0;f VVO <br />