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WWWMA, <br /> r r <br /> J h <br /> SAN,TOAQtiINCOUNTY <br /> ENVIRONMENTAL HEALTH DEP.ART-NIENT <br /> AUG Z005 344 East Weber Avenue,31`d Floor, Stockton, CA 95202-2708 jq313 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www sjgov.org1ehd <br /> ENVIRONIMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: bq'f_ U BUSINESSIAGENCY: <br /> ADDRESS: �-� V`-^� Or. T'�r\a�1C C{F �tVI-til <br /> PHONE(1): ZIT ���- �� PHONE(2): FACSIMILE: Lit L67- 4'06[5 <br /> TENTATIVE"APPOINTMENT DATE: Time: O't <br /> (Please allow 10 business days from date of application submittal•'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$`97.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3USINESS DAYS <br /> SIGNATURE OF APPLICANT /*r- V—J�` I DATE erl <br /> UNIT DISTRIBUTION ❑Unlet ❑ Unit2 C3 Unit Unit ❑ Unit s ClUnk6 13 Other(electroniUlistshnaps) <br /> FILE ADDRESS I EHD USE ONLY <br /> Streeta Street Name City <br /> 1. IIS t oA1 5 i S ttc <br /> 2. Lj<x TS t mch." i t.K a , , <br /> 3. "5'302 Z%X Lo, S LL <br /> 4. Z7_`It35 e' 35,21, rwr <br /> TAt at PA. Est lea- 02 <br /> S �,IC ^ Ak <br /> 7. Cn`0 I _sr4.L l� <br /> 8. lv o Yn lLa i CK YYf <br /> I � yv� <br /> '10. v e• MorC q 14Ai 5 L <br /> ±I!i Ea <br /> Specific Date Range of Information Requested:FromZ`y03 to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> i <br /> *bVDERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NowLOP) ❑FOOD FACILITY ❑WASTETIRE <br /> ❑ UNDERGROUNDTANK(MONITORINGIREMOVAL) ❑DOG KENNEL In DAIRY <br /> LJNI1EAWtKl6WASTE CBIOtlLTOR aGaalaail'NM1mN dMfAbrr!NYA1CIt 7RM1MIrfITh>SfIT <br /> ❑TIERED PEnwTTEo FACILITY ❑MOTEUHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTODIBODY PIERCING ❑POOIISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECDRDs ARE AVAILABLE FOR RENEW - MONDAY-Fra DAY8:0OAM3:00PM - EXCLUNNGHOUDAYS. <br /> I. 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 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 stal 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 /> ----- <br /> EHD a-orcns <br /> tI1CN5 I <br />