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11/01/2007 15:38 FAX -- U002 <br /> ALCOVIED EHD LOG NUMBER <br /> SAN.�OAQUIN COUNTY <br /> hUV. 0 12007 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 00 <br /> ENVIRONMENT HEAL%Iephone:(209)468-3420 Fax:(209)464-0138 Web:www.s goeh <br /> PERMIT/SERVICES <br /> y� PUBLIC RECORDS RELEASE APPLICATIO <br /> APPLICANT: r t7�I � f��"�� f BnU,.SINE`S, lPSIAGENCY. t <br /> ADDRESS: $ v « �t7 <br /> aD L.ss Atv <br /> PHONE(1): 1' ''1 {3'" 7 PHONE(2): FACSIMILE: C'„'�,�� �`/ZJ—SID I <br /> TENTATIVE`APPOINTMENT DATE: NV Nw - Tlme: Ir'OF Q - <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must h0 eenfirmed) <br /> CHECK BOX TO EXPEDITE REQUEST(-$9E FE C OR CHEC ONLY)-REQUEST PROCESSED IN 3 FI I ESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map— crlption: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Name City ❑ unit 1 <br /> 2 ❑ Unit2 <br /> 3. <br /> 4. Unit 3 <br /> 5. <br /> s. <br /> 7. <br /> Air <br /> $. Unit 5 <br /> 9. <br /> �.— ❑ Unit 6 <br /> 10. d A <br /> Specific Date Range of Information Requested:From JAN(A-WI� 1 to to fLIL a�1� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> h <br /> NDERGROUND TANK(UST)CLEANUP SUE(LOP) 171HOUSING ABATEMENT O SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) O FOOD FACILITY la WASTE TIRE <br /> ,.UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREArMENT PLANT <br /> ❑TIERED PERMITTM FACILITY ❑MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM To1LETs <br /> 13 TATTOOMODY PIERCING ❑POOLISPA ❑LAND USE APPLICAT ON SITES <br /> ❑MeoicAL WAsTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-S:OOPM -EXCLUDING 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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above._ Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> 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 applicant <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> elm 4a-05 wee Ilrerz007 <br />