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04/11/2005 09:08 209-57" ''225 P10DEST0 ATC / � /J AGE 02 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY � <br /> ENVIRONMENTAL HEALTH DEPARTMENT � b <br /> t t 304 East Weber Avenue, and Floor, Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: wRR �t"'W"'RR <br /> m 91 50 <br /> PUBLIC RECORDS RELEASE APPLICT12N <br /> 6Nili 66NU Y <br /> APPLICANT: J%.,,, KM.,de✓� BUSINESSIA YIAT�,IH,�Adcb�il cS <br /> ADDRESS:_ IIi� Last. Pal... A4 e S 4e -6 rleJarfo l A� <br /> PHONE(1): PHONE(2): 2n4MJR- FACSIIs <br /> : <br /> TENTATIVE'APPOINTMENT DATE: 4 - i V-O j TTma: <br /> (Pisa"slow 10 business days from date daof application aubn Uel-•Tonbew oniy'TTN <br /> l!e <br /> CHECK BOX TO EXPEDITE REQUEST-/$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 4-11•nS <br /> r <br /> UNIT DISTRIBUTION ❑ Unit 1 0 Una 2 0 Unit 3 0 Unit 4 O Unit S 0 Unit 6 0 Other(eMc6onidllats/msq) <br /> FILE ADDRESS END USE ONLY <br /> "add Street Name city <br /> 1. 1 S. Frmte.s K L+ <br /> 2. t W. C W+ S4sekfin. <br /> 3. IVI f. ... f .k <br /> --J 4. 20 <br /> 1 <br /> ot e <br /> 5. 1 . r' <br /> 6. 20541 - 54%.k <br /> 7. 444__„ T.q: 4wr ti <br /> e. 11 I A/ <br /> 9. _- <br /> 10. <br /> Spaeifie Dab Range of Information Raquaslad: From toU! ot <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES _��'p�t1 ot <br /> UNDERGROUND TANK JUST)CLEANUP SITE(LOP) 0 HOusINO ABATEMENT O SOLID WASTE FACRZTfIrN9ckl 3 05 <br /> p.OTHER CLEANUP SnE(NON{Op) 0 FOOD FAcam O WASTE TIRE <br /> UNDERGROUND TANK(MONnORINO/REMOVAL) G Doo KENNEL c DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANcN O WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTELMOTEL 0 PUMPER TRUCKNARDICHEM TOILETS <br /> 0 TATTOO/BOOT PERcIso 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACA.ITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW- MONDAYFMOAY 8:00 AM-6:e0PM - EXCLUDING HOLIDAYS. <br /> 1. List up to len addresses In the space above. Select the type(s)of flies 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 mall to the address <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 notify the applicant If any EHD files 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 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 expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END Ya]iM <br /> vlA <br />