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12/04/ 006 12:06 FAX lih002/002 <br /> �7 ENVIRONMENTAL I-II _T 1 '• rHkx ui <br /> 11/1 , EHD LOG NUMBER <br /> ��, SAN JO A.QUIN COUNTY „y <br /> 7 U_LS-jjjFj& 0 4 2006 ENVIRONMENTAL RUAL'TH DEPART <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 / 7z, <br /> NMENT H%gi6one:(209)458-3420 Fax: (209)464-0138 web: www_sjgov.org/ohd / /� <br /> L• PERMIT/SERVICES <br /> / PUBLIC RE' CORDS RELEASE APPLICAHON <br /> APPLICANT:_.�,J GtsS�.+ �+//,e�ipusr ESsracENCY: <br /> AVDRESs; <br /> PHONE(1): -1 7"15 PHONE(2): FACSIMILE: 9 t7 9-06 a) <br /> TENTATIVE*APFOMTMENT DATE: lime: <br /> (Please snow 10 liminess days from date of application submrU.`TentabYe only-must be firmed) <br /> CHECK BOX TO EXPEDITE REQMT-596.00 FEE(CASH OR CHECK ONLY)-REOUEST PROCESSED M 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Street# Street Nanta City <br /> ,- V v\\, ❑ Unlit <br /> )= LJ <br /> 2. .Unit 2 <br /> 3. <br /> ,sT H vJ r unh 3 <br /> � y; 5 <br /> I�Unit 4 <br /> 7. v UNt S <br /> 9- > ''9 unit e <br /> Specific Data Range of Information Requested-From to <br /> qENVIRONMENTAL HEALTH DEPARTMENT FIL15S <br /> LY UNDERGROUND TAM(UST)CLEANUP SME(LOP) ❑ HOVSWO ABAT6MlNT PkSOUD WASTE FACOrrv1V7ecU <br /> R OTHER CLFANUP SRC(NoN-LOP) 0 FOOD FACLr Y O WAST2 Tau <br /> 91 UNMGPAVW TANK(MONITOkINGIREMOVAL) UDoe KbMEL PL DARRY <br /> Pk AZARpGO9 WASTC 13ENWA-MR WCHICKEN PINCH WASTLWATCR TTtrATMENT PLANY <br /> ❑ TIRRED PMU14 YSO FACrLRY Q MOTiLAioTrL PUMPER TRUGK/TNmICHEM TQ"Ta <br /> M TATTOO/BOOY PICACM0 M POOLISPA LAND Usa APPLICATNM DIES <br /> 0 MEDIC"Wa FAQP-M ❑OrnER(PLrAse SPECIFY) _ <br /> WeU-Amo S"ma Pe rr Rxcofts AHE AYAnAnIe FOR RLMEW - MRNOAY-FRIOAT 6:00 AM-5:00PN - ExCLVOwa HO_LIDAY9. _ <br /> 1. <br /> Litt up to ten addrasses In the space above. Select the type(s)of tiles from the list above by checking the appropriate <br /> box(es). At least aria file type MUST be selected, Fax to(209)464-0138 or mail to Tho address Indicated above. Address <br /> ranges will not bo.accepted-for additional assistance with file addreesas,contact the EHD.Applications received after <br /> 5:00 pm will be procaased the next business day. <br /> 2. The EHD will natifythe applicant If any EHD files exist. An appointment for review will be confirmed apprmAmatoly tan(10) <br /> days after rocelpt of application. The filos will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A.file that Is actWy being worked on by EHD staff may not be immediately available for review. A new appiicatlon may be <br /> submitted when the file Is ava(lable. � <br /> 4. Any file not returned in the sama condition as r■leased will be reorgani::ed by EHD staff at the expense of the applicant <br /> Future file reviews by the same applicant may requlra a$95.00 deposit prior to review.. <br /> EHD USE ONLY <br /> MV fent 9n ooa <br />