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rtn. li. z0UU/21: IlYM ILNNASEANCH INC N0. 8578 P. 1/2 <br /> u V fS�D 1' SAN JOAQUW COUM Y EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 13 2007 304 East Weber Ammue,37d Floor,Stookton, CA 95202,2708 <br /> ENVIRONMENT HEALTH Telephone:(209)468-3420 Fsa:(209)4640138 Web:www.sjIgov.org/ehdI <br /> PERMIT/SERVICES PU/B�LtIC RECORDS RELEASE APPLICATION i <br /> APPLICANT; K=a Q-1^ BUSINESSIAGFNCY: <br /> ADOPEss: -7 r1 Ga �- <br /> PHONE(1): 2'I'b'b b�PHONE(2): IZ-�S `1 gt4--Z6ti�.^ ACSIMILE: <br /> TENTATIVE` 4PPOINTMENT DATE:�2 tYl rme: 1 t7 A +i1 1 <br /> (Plea aHOWIOlwSlnessdays fromdofapphcatlonSubmittal-•TeritaWeonly-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE RE ST-493.00 FEESH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN SS DAYS <br /> SIGNATURE OF APPLICAN Lr DATE I� <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD 70, <br /> Streets Name city <br /> 1• Unit <br /> 2 �3.4• <br /> b. <br /> Unit <br /> 7. <br /> 8. ❑ units <br /> 9. <br /> 10. <br /> Unit a <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDEROROUND TANK(UST)CLEANUP S:TE(LOP) ❑HOWwGAaAwuENT iS� WASTFADiL /VEHICLE <br /> EV <br /> CLEMIEP SrrE(NONLOP) 0 Fouo FAr4UTY Q 4�R§TE TIRE <br /> JUNDSimoum TANK(MONITORMOIREMOVAL) ❑pod KENNEL m�AIRY <br /> ,96THER <br /> FJA22ANDvm WASTE GENERATOR ❑CNICKEI RANCH d WASTEWATER TREATMENT PLANT <br /> IEREDPFRAnTEDFAcILnY 0 MOTELIHOTEL d PUMPER TRVCNYM9CHEM TOILETS <br /> TATTOOMODYPIERONG MPOOLISPA CI LANDUsEAPPLICATIONSNES <br /> MEDICAL WASTE FACILM /� ❑OTHER(PLRASE SPEOWY) <br /> WELL ANO SEPnc Pmrr RECORDS ARE AVAILABLE POR REYww- MONDAY.FRIDAY 6:DD Ah15:00PM - ExcWDmO HOLIDAY& <br /> I. 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 64 <br /> to 209 44138 or mall to address indlented above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,confect 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 fora maximum of five business days for review. Appointments <br /> should be scheduled accordingly, <br /> 3. A file that is actively being worked on by END 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$96.00 deposit prior to review. <br /> EHD USE ONLY <br /> rvc4 aY3O600 <br />