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U,/18/2006 10:59 FAX . Z 002/002 <br /> DATE RECENED 0 SAN COUNTY EHD LOG NUMBER <br /> RE FF V E 4N�oNMENTAL HEALTH DEPARTMENT <br /> J A P f 1 �• , T East Weber Avenue, 3`'Floor, Stockton, CA 95202-2708 <br /> 'I�Qep Dne: (209)468-3420 Fax: (209)464-0138 Web:www_sjgov_org/ehd 107 13 <br /> ENVIRONMENT HEALTH <br /> PFRMIT/SERVI(MLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: M05802 BUSINESSIAGENCY: _LC—�__ <br /> ADDRESS: �` CTT7__STOC ~Ci I STATE, T <br /> PHONE(1 —` PHONE(2): FACSIMILE fl�—C)(,Z-1 <br /> TENTATIVE"APPOINTMENT DATE. .f L /C)(o _ Time: _ <br /> (Please allow 10 business days from date of application submittal-7arttadve only-must be confirmed) <br /> © CHECK BOX TO E XPED(TE REE T-593.00 FEE( SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> �� SIGNATURE OF APPLICANT DATE IV Off_ <br /> � Electronic <br /> Information ❑ Llst C3Map-Description <br /> FILE ADDRESS EHD USE ONLY' <br /> Street>T Street Name City <br /> 1' ?' ElUnit 1 <br /> Z• L !cz) EP <br /> 3. P14'1 r. a Unit 2 <br /> 4. 1 Cb Rjl� <br /> S. �Unit 3 <br /> 7, Unit 4 <br /> e. <br /> y. Is <br /> ElUnit 5 <br /> 10, Lf Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tif UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOUR WASTE FACILrryfvF 11CLE <br /> .OTHER CLEANUP SITE(NON-LOP) ❑FOOD FAcaj" O WASTE TIRE <br /> 12RUNPERGROUNDTANK(MONITORiNGIREMOVAL) ❑DOG KENNEL f7 DA1RT <br /> IIQ HAZARDOUS WASTE GENERATOR i]CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> ❑ TIERED PERMITr D FACIUTY ❑MOTELIHOrEL 0 PUMPER TRUCKIYARDICHENK:AL ToLcTs <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA )q LAND USE APPUCAT*m Snu <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERNR RECORDS ARE AYAILA91-e FOR REVIEW-MONDAY-FRIDAY 13:00 AM-5:00PN - EI(CLUDING HOUDAys. <br /> 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the ziddress <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3;00 pm will be processed the next business day. <br /> 2. The EHD will notlfy the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after recelpt 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 EHD 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 EHD staff at the expEmse of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END 4" <br /> 10MIM06 <br />