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7- 7-06; 1i :06AM; ;2099336960 # 3/ 3 <br /> 0 7IO6!'2006 X4[1 ENVIRONMENTAL HFH PAGE 02 <br /> DACE RECEIVED C I %V'/I I , '^ *r' � '- " LI <br /> S <br /> L� ll AI�I ,.A.( i1XN COUNtY <br /> fc:� .ins?.. ) ?,1,� NN7jp �`r 'IEALTifHDEPA.RTMENT <br /> east Weber Avenue, .) Floor,Stockton, CA 95202-2708 c17 <br /> pf.T ff9)468-3420 Fax: (209)464-0138 Web: Wwv.sjgov.ozg/ch;Z <br /> PU�B44 <br /> lIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Mick,o I genastrio_w6bs r EUSiNESS/AGENCY; Co!jI?S4V%,rj' jZdIAe �11IEl�a <br /> ADDRESS: Z'.02. Vra( 49'V °w _ 1_VVt SN1 N 140 �S+D 9403a� GA `%�Zd� _ <br /> t'3IONF.(1):_Zai. `l83 ,S2K1 PHONE 2 �_ <br /> {z): '"' �Ac�iMu.E: Q1• q q_(a Ca <br /> cA <br /> j TENTATIVE*APPOINTME14T DATE: Ari AP Titie: <br /> { (FTaase allow 10 bUSiheSs days from date of application submittal'-"Tertalve only-must be confrmed) <br /> CHECK BOX TO EXPEDiTE REQUEST-Sg ,o FE (CASH OR 1AHECK ONLY)-REQUEST PROCESSED IN 3 BUSiNESS VAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT CISTRiBUTiON 0 Unit 1 E7 Unit 2 0 Unit 3 0 Unit 4 0 Unit 5 ❑ Unit G 0 Other(eleo:ronidlists! aPS) <br /> FILE ADDRESS _ EHD USE CsNLY <br /> Street# Street fume City <br /> 1. 3ZcaI <br /> i <br /> 3. <br /> k7. _ <br /> 10. <br /> -Sgecific_Date Ranpe as Information Requested:From �j AIS <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> V . <br /> i ED UNDERGROUND TANK(UST)CLEANUP SiTE(LOP) 0 HOUSiNG ABATEMENT 11 SOLID WASTE FACILITY/YEHICLE <br /> Q OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 1YASTt TiRE <br /> El UNDE.RGROUND'TAI4K(MONITORING/REMOVAL) Q DOG KENNEL 0 DvPY <br /> 10 HAZwDous WAm'z GENERATOR Cl CHICKEN RANCH ❑1�ASiEWA7ER TREA7tdEN i PLANT <br /> rl TIERED PERMITTEE FAOILITY Ea MOTELIHOTEL O Puvi prR TRLICKIYARL,104 m TOILETS <br /> f 0 TATTOCIBODY PIERCiNG ©POOWSPA r E LAND Use APPLICATION SITES <br /> ll C7 MEDICAL WASTE FA:ILnY HE <br /> 0 OTR(PLEASE SPECIFY)�mr I& <br /> SSC S�t <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8.00 AM4:00PM - EXCLUDING HOLIDAYS. <br /> 1. List tap to ten addresses in the space above. Select the type(s) of files frorn the list above by checking-� the <br /> 1 appropriate box(es). At least one file type it+EUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated abo{e. Address ranges will not be accepted-for additional assistance with file addresses,oontac; <br /> the EHD. Applications received after 3:00 prn will be processed the next business defy. <br /> 2, The EHD will notify the applicant If any EHD files exist. An appointment for review vlrill be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum cf five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3, A file,th;;It i�;awtively being worked on by EHD staff may not be inimediaitely availablP 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 taff at the expanse of tete <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to roview. <br /> RHD 4u U6 <br /> J74(06 <br />