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16/2006 10: 59 FAX • Z 002/002 <br /> DATE RECENED _ Q��Q EHD LOG NUMBER <br /> �E"E� WE LNVIRONMENTAL HEALTH DEPARTMENT <br /> JAN I " p (� East Weber Avenue, 3`"Floor, Stockton CA 95202-2708 <br /> i eQep`hone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ENVIRONMENT HEALTH <br /> PFRMIT/SERVITUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: &�Ar!j_- i3tQ'S1yS BUS[NESS/AGENCY: <br /> ADDRESS�yy� /Z�ZS� CITY__ST C*—T 14 STATE___Q_� <br /> PHONE(1)Yl-F,AL��LE PHONE(2l: FACSIMILE: ja—n/9 <br /> TENTATIVE"APPOINTMENT DATE: 2 f I /n(c Time: I Z _ <br /> (Please allow 10 business days from date of application submetal-•Terta6ve only-must be Confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQU T-$93.00 FEE( SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE IlIrlElectro— Dom_ <br /> IiG <br /> nfa maflmon ❑ Llst O Map-Descmptlon <br /> FILE ADDRESS EHD USE ONLY <br /> Shae[i Street Name City <br /> 1• el <br /> z. <br /> c I O Unit 1 <br /> S <br /> a. ti I cc rl E<-' ,� Unit 2 � <br /> S. Unit 3 <br /> 7, Unit I��1 <br /> s, <br /> y ❑ Unit 5 <br /> 10. I I I I I ZUnit 6 <br /> Speolflc Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> of UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) O HOUsINO ABATEMENT IM SOLE)WASTE FACILrrYNENICI.E <br /> t�Ey.OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACLm CO WASTE TIRE <br /> WUNOERGROUND TANK(MONRORINGIREMOVAL) O DOG KENNEL 'Q DA1RT <br /> OA HAZARDOUS WASTE GENERATOR C7 CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> ❑TIERED PERWITED FACUTY ❑MOTELMOTEL OPUMPER TRUCKIYARDICHEMICAL TOILETS <br /> 173 TATYOOIBODYPIERCING MPCVJSPA )q LAND USE AFPLK:ATToN SRLS <br /> O MEDICAL WASTE FACILITY O OTNCR(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAIIwRLE FOR REVEw-MONDAY-FRIO"9:00 AA":OOPM - E%CLUmNG HOLIDAYS. <br /> 1, List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the alddress <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after$:00 pm will be processed the next business day. <br /> 2. The EHO 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 exptlnse of the <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> eNo Asa <br /> �OfJV2W6 <br />