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06/31/2006 QED 10;44 FAI 551 J17 2886 BSK Environmental � �j0021002 <br /> AT O E ffF[D SALT JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> f AY 3 1. 2006 304 East Weber Avenue,3d Floor,Stockton,CA 95202-2708 <br /> ENVIRONMENT HEXEMboae:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org10hd 3 q3j <br /> PERMIT/SERVICES puBLIC RECORDS RELEASE APPLICATIOpN <br /> � <br /> APPLICANT: (hl)�C 1"(t(lEhl'Z LG BUSINESSIAGENCY:_BSk A.t$66)4TgS <br /> ADORMU_ 67 W. CMAw EyICNuc) Su f{ Ej <rAot CA 93709' - <br /> PHONE(1):_5 ,•r , y . ZPfG <br /> T ENTATNE'APPOINTMENT DATE: fO//S/O CO Tbna: YDa„7 <br /> (Please allow 10 bU3111 a days tram date of applkaaan submt1tal-*Tena)only-Mutt be wrtfirlmd) <br /> 17 CHECK 80x TO EXPEDITE ES -$83.00 E H Oft CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Z7iW -DATE _ d <br /> UNIT DtSTRIHUTION O Unkl O Un CfUna3 O UnitA O UnItS D Unite 0GTDor(elacVulialiatsfiups) �� <br /> FILE ADDRESS <br /> j— tro me <br /> uny <br /> `C <br /> AJAVYAAMa Szo-./eroA/ __ _ <br /> 2 2417 ✓y DIVVG• _/ s __--- _ <br /> ........... -3. 3olS N9�Y-1��iur+— ---- <br /> 4, 3ool /VA" AA.IU6• s�w�a✓ _. --- .. <br /> 5. 251/ 'Ah �Ye sr«eyort� \ <br /> - J,- AIA 00.' JD I LF6• - Sreuct'o _ <br /> "A✓V_�1//E N F. r .ryoytrbpl _ <br /> 9. - <br /> 10. <br /> Speclfk=Date Range of Information Requested:From Y4L) to Go <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND Taal(UST)CLUMP SITE(LOP) O HOUSING ABATEMENT ❑Sam WASTE FA AunNENlcu <br /> OTHER CLEANUP SITE(NOW-LOP) 171 FOOD FACILITY O WA TIPS <br /> UNUUMROUND TANK(MONTIORINGIREMOVAL) ❑DOG KENNEL 13 DAu;Y <br /> HAZARDOUS WASTEGENERATOn ❑CHICKEN RANCH ❑WASTEWATERTR? TME .PLANT <br /> TIERED PERMITTED FAORM D MOTELIHOTEL O PUMPmTRUCK/YAnorCHEP1 ToiL eTs <br /> O TATTONBOOT PIERCNG ❑Pomts?A D LAND USE APPUCATUN SRF.S <br /> MEDICAL WASTE FACILITY C1 OWER(PLEASE SPEQFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Roam- MONDAY-FRIDAY IEW AMS;00PM - EXCLUDING 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)464.0133 or mall to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,conOrt <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 behold 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 ova liable for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any filo not returned In the Same Condition as released will be reorganized by EHD staff at,the expenae of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> tTfo+e-uuas <br /> L1(N5 <br />