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12/04/ 006 12.06 FAX �^ s!, U002/002 <br /> ENVIRONMENTAL i_ _TI <br /> ", , EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> 0 4 2006 II NVMONMBNTAL HEALTH DLPART V y <br /> 1 �5 304 EaSt Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> ' �A RONMENT H6 14fione:(209)468-3420 Pax: (209)464-0138 Web:www.sjgay.ors/ohd ,n <br /> PERMIT/SERVICES 2'� (v/ <br /> PUBLIC RECORDS RELEASE APPLXCA' XON <br /> APPLICANT: gUS NESstAOCNOY: 1C_Z,-1� 4`a f 0)d-- <br /> APDRESS; ®�+S.�.S /�� MY�TI L 57- <br /> PHONE(1): ;2O9 -j')S-) 7'15 PHONE(2): - FACSIMILE: 9`t 8-06;;t <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please Blow 10 business days from date of epproefinn submrtW--r*nf2Vve only-must De firmed) <br /> CHECK BOX To EYPED1fE REQMT-596.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stroet# E4tet Name Cky <br /> V v� Unit <br /> m'i s oa d Syo�qtr Q <br /> 2 _ (� Unit 2 <br /> 3. <br /> - h3YY1 �Rr �� ✓ O ST H L)J f�47UnR4 <br /> Unit <br /> 5. <br /> S. '- <br /> 1a. X <br /> ULU <br /> Specific Data Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> CQ UNWRoaouNa TANK(UST)CLEANUP SIE(LOP) ❑HCUSM AEATEMEWTlQSOW WAsrm FACaMP?M*CU <br /> t: <br /> Pk OnmR rmup SRE(ibN{OP) O FOOD FACalrr d WAM Tata <br /> 1A waovRoiwurm TAW(MONIroRNo1REMcVAL) 0 Don Kftmm PL DAIRY <br /> P.HAZAR=M WASTE r3EMBRATOR L1 CHICKEN RANCH '{p-,`WASTewM1TER TrtEATMEW PLANT, <br /> O TIR ED PERM"M FAC I.nY E3 MOl[ll"Ma S PUMPER TRUCKNAKnICHEM Token A <br /> *TATmO100cYPKRCH40 MPo00SPA ARI LAND Wit APPLICATION SIVA <br /> P MEDICAL WASTE rAwv o OmeR(PLEAsa BPECIFY) . <br /> WELI.AM SEMC PElanr PACURD9 ARE AVAKuLE FOR REVIEW- MonOAY-FRLDAT 6:00 Am-s:owu - EKcujom HOLIDAY& <br /> 1. Uet up to ton addresses In the space above. Select the tYpe(S)of files from the list above by checking the appropriate <br /> box(es), At least ono file type MUST be selected. Fax to(20914640138 or mail to tho address Indicatedabove. Address <br /> ranges will not be aecepted-for additional assistance with file addrsssas,contact the EHD.Appllcationa received after <br /> 3:00 pm will be processed the next business day. - <br /> 2. The EHD will nodfythe applicant If any EFID files exist. An appointment for review will be confirmed approximately ton(10) <br /> days after racelpt of application. The files will be held for a maximum of five business days for review. Appointment$ <br /> should be scheduled acooivringly. <br /> 3. A.file that Is activety being worked on by EHD staff may not be immadiatoly available for review. A new application may be <br /> subreltted'when the file Is available. , <br /> 4. Any file not returned in the same condition as released will be reorg2ntsed by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to revlew.. <br /> EHD USE ONLY <br /> XP NU6$1 ooc <br />