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8. 2006 9: 16AM CONMR EARTH TECH NO. 5521 P 2/2 <br /> ,r EHD LOC-NUMBER <br /> g J IIJ I5[Q)� SAN TOA QUIT COTI'M <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3 Floor, Stockton, 95202-2708 <br /> Telephonic; (20)468-3420 Fax:(209)464-0138 Web: <br /> wwwsjgov.org/ehd <br /> JVIRONPIENT tIT:ALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> rc <br /> APPLICANT: ._ASA j/Q,ryI �BU�SI,NAESSIAGENCY: I�fJ nI <br /> ADDRESS: ISS .fr�K(+T C+tR�I�+ tu'i�� 1,. "io'•( "`• <br /> PHONE(1): gkg 4"O51$ PHONE(2): 209 9 AUO FACSIMILE: 0 9— _1i 5M <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 b"nom days from d of application Submittal•-TentabW only-must be confinncd) _ <br /> CHECK BOX TO EXPE RE EST-$93_0017 ( H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS S <br /> SIGNATURE OF APPLICA T DATE O <br /> UNIT DISTRIBUTION ❑Unitt Q Unite Unita ❑UnR4 ❑Unit5 UnRe t7 Other(electronldlatslmaps) <br /> FILEADDRESS EHD USE ONLY <br /> Stre¢tM Sheet Name City <br /> 2. S6fJ <br /> 3. INJ <br /> 4. O 1 <br /> 5. <br /> 7. Ai•Q <br /> 8. G rtMMr 4TngA�TACNTP��IqL160 Specific Date Range of Information Requested:From to <br /> �� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ips UNDERGROUND TANK(UST)CLEANUP SIT.(LOP) HOUSING AOATEMENT a�LO WASr07ER CLEANUP SITE(NON-LOP) Ooo FAci= o WA 'I IRE <br /> �uNOERGROUNOTANK(MONrrORINCAREMOVAL) OG KENNEL ❑DAIRYHA RDOUSWASTEGENERATOR HICKEN RANCK ❑WASTEWATTIERED PERMITTED FACILITY _ 0 MOTELIHOTEL 0 PPUMPERTR <br /> 13 TATTOOIDODY FIERCING 1 ❑POOL15PA Yo LAND 1J6E APPLICATION SITES <br /> ❑MEDICAL WASTE FAGLATr ❑OTHER(PLEASE SPEGPY) <br /> WELL ANO SEPTIC REGORDa/IRE AVXR LE FOR REVIEW- MONDAY-FRIDAY 6:00 AM-8:0DPM - EXCLUDING HOUDAY5. <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 address <br /> indicated above. Address ranges will not be accepted-for addit oval 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 /> EHD C9A2d06 <br /> 1MNC6 <br />