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12/12/2005 10:51 FAX 91685291IQ Geocon Consultants 0,001/001 <br /> I <br /> DATE RECEIV�p_. <br /> _ ,L ,,-��I , II I�__ �I 1) SAN JOAQUIN COUNTY END LOO NUMBER <br /> IUj�,-'ju51(IlLr��,"'((V��(J\`J. Ilj V ENVIRONMENTAL HEALTH DEPARTMENT <br /> ' LN5 304 East Weber Avenue,Yd Floor, Stockton,CA 95202-2708 <br /> ULC , 2 Telephone: (209)468-3420 Fix:(209)4640138 Web:www.sjgov.orp./ehd <br /> EIVVIRONPSEPI� HEALTH PLIC, RECORDS RELEASE APPLICATION <br /> PPucAN7: <br /> UMNESSAGENCT: V ILA O - LL �o V <br /> ADDRESS: 311aUD C•sold k,, YM"2- <br /> p y <br /> fZ@�'�T'� LQ bJ9 � ` "2- <br /> HONE(1)I "x1110 — F,57..- n(1 ('R PHONE(2): q1 •�141(� FACSIMILE: Le - 1111S2:.L91 <br /> LISIGNATURE <br /> ENTATIVE`APPOINTMENT DATE: Time: <br /> (Pies"■Ilm 10 bualneee days from data of epPllatlon submlltal-•TsDtaNre only-must bs oonfl - ) <br /> % CK BOX TO I7WEDRE ES -583.00 FEE(Cas R CHECK ONLY)-REQUEST PROCESSED INS BUSINESS DAYS'Tj <br /> OF APPLICANT C DATE ��2--�pj_ <br /> TION O Una 1 0 Unit 2 O Una 3 O Un4 4 O U it S O Unit S O Other(alectronlcRlstWinaps) f <br /> FILE ADDRESS EHD E ONLY ` <br /> _ q StnrotN street NamC - J <br /> CdA} 1. <br /> 2 Z <br /> 3. <br /> 4. O <br /> t 5• � <br /> 0 <br /> a& TOW <br /> 1 9 <br /> 10. <br /> Specific Date Range of Information Requested:From_AM"Awhaffiap toTze! • <br /> ENVIRONMENTAL HEALT EPARTMENT FILES <br /> 10 UNDERGROUND TANK[UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT / SOUD WASTE FACILrIYNEHICLE <br /> )EPOTHER CLEANUn Srm(NON4-OPI 0FOOD FACILITY '11 WASTE TIRE <br /> UNDERGROUND TANK(MOHn1MNGftMOVAL) 0 Doe KENNEL DDAIRY <br /> OD <br /> A2ARD3 WASTE GENERATOR 0DHIOIWN RANCH �®p+WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY t7 MOTELIHOTEL O PUMPER TRUCKIYARDICHEM TokT.78 <br /> 0 TATTOOIBODY PIERCING 0 PMJSPA j91L.allo USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILM 0 OTHER(PLEASE SPECIFII <br /> WDLL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REMEw- MONDAY-FMDAY 6:00 AM-5:OVPM - EKCWDINO HOUDAYO. <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax jo(209)464-0138 or mall to the address <br /> indicotpo above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHO.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD flies exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The flies will be hold 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 EHO 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 some applicant may require a $93.00 deposit prior to review. <br /> eNo�eazme <br /> utuaa <br />