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03/09/2005209522'4422�12277 G LOGICAL TECHNICS PAGE 01/01 <br /> DATE RECEIVE( • •���F EHD LOG NUMBER <br /> nD AN JOAQ OUNT <br /> W E C ENED ENVIRONMENTAL HEALTR DEPARTMENT <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202-2708 <br /> MAR 9 - 2005 Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgoy.org/ehd <br /> So <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> t l <br /> P RMtorrivIC <br /> APPLICANT: o- &q- (,rBUSINESSIAGENC/Y: !'a-r �C/YI/CT�p7G+, <br /> ADDRESS: / rI'&'r f FR-{L) S Z/ ' <br /> PHONE(1): yI ry�" % PHONE(2): FACSIMILE: 6.-OD67 7 <br /> TENTATIVE"APPOINTMENT DATE: Tlme: W ` <br /> (Please allow 10 business days from date of application submittal•'Tentative only.must be confirmed) <br /> C] CHECK BOX TO EXPEDITE RE EST•$9 OO F E(CASH OR CHECK ONLY).REQUEST PROCESSED IN$BUSIN SS DAYS <br /> SIGNATURE OF APPLICANT A!'d7�+7ts<2d f15DATE S <br /> UNIT—DISTRIBUTION ❑ Unit 17 Unit ❑ Unit IjMnit4 Q Unit ❑ Unit 6 ❑ Mor(alectronicllielslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street Street Na City <br /> 2. <br /> 3• Inca <br /> 6. .1 �: <br /> r. <br /> s. <br /> Alk A <br /> 9. <br /> 10. i <br /> Specific Date Range of Information Requested:From to <br /> ,.!Q, b` ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �UNDERGROUNDTANK(USTI CLEANUP Sat(LOP) ❑HOUSINGAGATEMENT b SOLD WASTE FACILITYNEHCLE <br /> OTHER CLEANUP$ITE(NON.LOP) 11 FOOD FACILITY 13 WASTE TIRE <br /> 4 UNDERGROUND TANK(MONITOmNGIREMoVAL) O DOG KENNEL 13 DAIRY <br /> ❑HAZARDOUs WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEUMOTEL 13 PUMPER TRUCKNARDICHEM TOILETS <br /> O TATrooleony PIERCING ❑POOLISPA ❑��L,,A((ND�USE APPUCATI� <br /> 17 MEDICAL WASTE FACILITY YOTTIER(PLEASE SPECIFY) <br /> T—'— <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW • MONDAY-FWDAY 8:00 AN{:DOpM - 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 <br /> appropriate box(es). At least one File type MUST be selected. Fax to(209)464-0138 or mall to the address <br /> Indicated above. Address ranges will not be accepted—for additional 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 /> END da-n2-088 <br /> tNVeS <br />