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04/242009 12:56 SIERRA -ITR CONSULTANTS LLC -� NO.955 D01 12094640138 � i <br /> I <br /> EHD LOG NUMBER it <br /> JOA <br /> UIN <br /> NTY <br /> G3 �� �� SAN ENVIRONMENTAL <br /> HEA TH DEP <br /> v ENVIRONMENTAL HEALTH DEPARTMENT n 1 <br /> J 304 East Wcber Avenue, <br /> 2 4 2009 3`d Floor,Stockton, CA 95202-27 <br /> 0r <br /> Tell (209)468-3420 Fax:(209)464-0138 Web:YfWW Sia K <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/ BUSINESSIAGENCY: S CNTA S <br /> APPt.ICANT: G` , <br /> 'Z1 C <br /> ADURESS: , rACSIMILE: M ell 130 <br /> PHONE(1): `�S• Z3 l PHONE(2): <br /> 71me:,�_�—� <br /> TENTATIVE'APPOINTMENT DATE: <br /> ly- <br /> (Please allow 10 business days from tlata of appllcalion aubmatel•'TankUve onmust be D IN 3 ROSINESS <br /> O CHECK BO%TO EXPEDITE REQUEST-$09.00 FE ASN OfJ CHECK S K) 5T PRODCEATE n IN 3 EIOSINIE ,OA� <br /> SIGNATURE OF APPLICANT /Unita, th1 ❑ Other alOctronlclf•,lllattslmaps) <br /> UNIT DISTRIBUTION <br /> ❑ unit 1 A Unit 2 �Unk a a Unit 4 �Unn S Lt unn 9 ( <br /> FILE ADDRESSStreet# EHD USE ONLY <br /> 6Ymat Name C Y <br /> 2. its <br /> 3. <br /> 7. <br /> 8. <br /> 9. <br /> 1D. to <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICLE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑WASTE TIRE <br /> TXER CLEANUP SITE(NON-LOP) L7 FOOD FACILITY M DARY13 DOG KENNEL <br /> Q CHICKEN RANCH 0 WAMTEWATERTRFA PLA <br /> EMOVAL) t] <br /> UNDENOROUND TANK(MONTORINGIRPUMPER TRUCYJYARD1CHFmOICHEM TOILETS <br /> - amOOUS WAyTE GENERATOR 13 MOTELIHOTEL <br /> I^G❑HTIEREo PERMITTED FACILITY C2FOOIISP0. ❑LAND U3E APPLICATIGN SITES <br /> ❑TATTOOISODY PIERCINO ❑OTHER(PLEAaE SPECIFY) <br /> C`MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW, MONDAY-FRIDAY 9:00 AM-5:00PM - EXCLUPWG aWDAY . <br /> ve <br /> y Checking the <br /> 1. List op to ten date box(es).SaS in the space abov At least one f to typo MUST be seleefeds Faxftos1209us4A138 momalbl to the address <br /> app p <br /> in isated above. Address ranges will not be accepted-for additional assistance with ti19 addresses, <br /> contact <br /> the END.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 The <br /> llnt be he review will im 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 at Is actively <br /> be submitted when the file D available not be Immediately available for review. A new <br /> app Yrganized by CHID at <br /> 4. Any file not returned fthe same condition as reuireoa$93 00 epos tt Priorfto re iv eexpense ofthe <br /> applicant, Futurr cant ma <br /> e fele reviews by the same Bpp Yy req <br /> �`oaaN�aw <br /> 11tMas <br />