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-DEC. 13. 2005 103P "DOR EARTH TECH 0. 4712 2 <br /> �!L_ <br /> Df�l'tr l,R',ECEI"VED a.r e. <br /> t_. SAN JOAQU N COUNTY ::,1'' •� a <br /> �I ENVM01NiymNTAL HEALTH DEPARTME-NT �! t <br /> 304 East Weber Avenue, 3'd FIooT, Stockton, CA 95202-2748 <br /> �r'i1�1 U1�,':I i HLAJx jcphome. (209)468-3420'F2.%-- (209)4640138 Web:www.sjgov.org/ehd <br /> RERMlT�SSE-FVICES <br /> PUBLIC RFCORDS RELEASE A.PPLICATIO\T <br /> APPLICANT: A F.Y BUSINESS/AGENCY, <br /> ADDRESS: n g 6-ab <br /> PHONE 0)- Z -��� PHOHE(2): DCII FACSIMILE: ~®s39 <br /> TENTATIVE*APPOINTMENT DATE: Time= t <br /> (Please atlaw 10 business days;frornndatc c p onsubmittal-'T-erltauve only-mustbe confirmed)CHECK BOX Tb DI E UEST- .l)0 c A CK ONLY)-P QUEST PFtOCcSSED IN 3 B SI A <br /> SIGNATURE OF ADPL I DATE <br /> UNIT DISTRIBUTION IS U 1 d Unit2 1:7 Unit ❑unit ❑Unit 5 d Una 6 a other(oloctronicflistsim2ps) <br /> FILL'ADDRESS EHO USE ON Y <br /> street 0 Strect Narita City <br /> 1. '7 I <br /> 4. <br /> 6. <br /> 7. <br /> 10. <br /> Specific Date Range of Information Requested:from <br /> �J/ ENVIRONMENTAL HEALTH DEPAP.7NIENT ,,,�y���ES ,.. <br /> li4 I�NoERGRoum TANK(UST)CLEANUP SITE(LOP) �U91NG AaATPMEty� �OLM WASTE FAcnnytVEH1 LE <br /> j� ER CLEANUP 51Te(NOM-LOP) C:Faoo FACnnY PASTE TIRE <br /> Fri ' OUNDTANK(MONT7RINC,lRAmoVAL) 0 DOG KENNEL �`ryuRY <br /> C1��7.0:111AROOUS WASTE GENERATOR ❑CHICKSN RANCH AB'TEWATER TREATUFNT PLANT `- <br /> TT£REO PERMITTED FACILITY d MOTELIHOTEL t7 PUmPERTRUCK1YARot0TtEM TOLLFITS <br /> y,_ m' <br /> C3 TATTOOIBODY PIERCING 13PoOLISPA If�D USE APPLICATION SITES <br /> 0-MEDICAL WASTE FACILITY ❑OTk<FZ(PLEASE SPECIFY} i <br /> WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVSEw- MO NOAH-FRIDAY a:UU AM-5:OOP111 - EXCLUDING HOL10AY5. <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 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 an 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 required$93.00 deposit prior to review. <br /> CAD"42-065 <br /> viko8 ' <br />