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07/31/2006 WED 10;44 FAI 559 "1 2886 BSK Environmental 02/002 <br /> DATE�l g��ME C) SAN JOAQIUIN COUNTY EHD LOG NUMEER <br /> �� ��LL�� lJ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3 1- 2006 304 Fast Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> ENVIRONMENT HEXLNhone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgoy.org/eiid 3 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICAT'ION <br /> � <br /> APPUGAt1T; 11�E I1<<� 1Z LG _SUSINESWAGENCY: S k As sd.e,_iAT t 57 <br /> ADDRESS'.:-5-0 W• NAW tLMVC) 5'01m ?37o'/ <br /> _ _ <br /> PHONE(7)._5 5Jq. '/77-21T6 1211 127 PHONE(2); 5 f . v7' 191'r- FACSW3LE 6j^, , 41kr _._ <br /> TENTATIVE*APPOINTMENT DATE: e15 5' 0� Tbne:.CD4� <br /> (Please allow 10 business days from date of application subMIMI.'Tentative only-must be v7ri imi d) <br /> CHECK SOX TO EXPEDITE ES .;93.00 E H OR CHECK ON11).REQUEST PROCESSED IM 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT DATE _ 14 6 <br /> U141T DISTPJ aV ON ❑ Unit 1 ❑U Fuamt 3 O Unit 4 ❑Unit 5 O Unit 8 ❑ Other(tWch oniaTists.maps) _ <br /> FILE ADDRESS EHD �O <br /> ee me <br /> AZAV1�r Szctel�tib.1J <br /> 2. 4,.4 y_•� ,,a✓Y Div��. - __ U e v --- i -- <br /> 4. ?b*1 / N.A✓f PAIr/e' I -._____L._. .- - -- --...—_.-- <br /> _. <br /> 6... .,r' n/A I!y�.�✓s' _. 5ra c.�cren/ <br /> -7. 3a x <br /> _2�_3.r' n/.Q✓Y—��d�E _... STocky'o- — -- <br /> 8. 'LL_Z-�' lVA✓'�_J�i�1�t` _. .Syoc,•F.ro,,� � _. �. <br /> 9: - <br /> Sp-cific Date Range of Information Requested:From �.! �/Q to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP Bar;(LOP) ❑HOUSING ABATEMENT ❑SOLS+WA3TE FAatjTYNENICLE <br /> OTHER CLEANUP SrIX(NoH-LOP) ❑FOOD FACIUTY 0 WAF E TIRE <br /> UNDEF.GROUND TANK(MON1TORiNGIREMOVAL) d DOO KENNEL ❑DAIP: <br /> FlAzARDous WASTE GENERATOR ❑CHICKEN RANCH ❑WAzTEwATER TRaATmENT PLAN': <br /> TIERED Panmi 7Eo FACILITY ❑Mo-MLnioTEL 0 PUMPER TRucK/YARoiCnrPi ToiixTs <br /> 0 TATTOOIBOOY PIERCING Cl OTHER <br /> El LAND USE APPLK:AnON 131r- <br /> ❑MEDICAL WASTE FACILITY ID OTHER(PLEASE$PEGIFY) <br /> WELL AND SEPTIC PERWIT RECORDS ARE AVAILABLE FOR REyiEw- MoNDAY-I�RIDAY 8-09 AM-5:oopm - EJCm=No HouoAYs. <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 mall to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with files addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. <br /> 2. The f=HD will notify the applicant if any EHD files exist. An appointment for review will I*Conflrmed <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 fila that is actively being worked on 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 expem3e of the <br /> applicant Future file reviews by the same applicant may require a$93.04 deposit prior to review. <br /> EHP 48-�2-C 98 <br /> �r�ams <br />