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FEB. 8. 2006 9: 16AM CONDOR EARTH TECH N0. 5527 P. 2/2 <br /> T EER <br /> SAID J�OAQLTW COUNTY HD LOG NUMB <br /> EN -fRONmNTTAL HEALTH DEPARTMENT <br /> 1006 304 East Weber Avenue,3'1 Moor, Stockton, CA 95202-2708 <br /> Telephone;(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> VIRO(df/1ENT I-!EALTH <br /> PERMIT'SORVICES PUBLIC RECORDS RELEASE APPLICATION/ <br /> APPLICANT: �a , •te•' a eJo� BUSINESSIAGENCY: 64 'tom <br /> AbIIRESS: 1 (K1FfV4G W, llR <br /> PHON1=(1):_*9-0+-051?, PHONE(z): Q9—�M- I Sal'K A= KACSUTAILE: A –cw`Y ^L)a� <br /> TENTATIVE"APPOINTMENT DATE: T(me: <br /> (Please allow 10 business days from dgeof application submittal-'TenfabW only-must be confirmed) <br /> CHECK BOX TO EXPE RE EST-$93.00 F ( H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS S <br /> SIGNATURE OF APPLICA T DATE D <br /> UNIT DISTRIBUTION r3 Unit 1 ❑Unit 2 Unit 3 l7 Unit 4 ❑Unit 5 ❑ Unit S ❑ Other(electronidlists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. AY <br /> 2. 56fJ- <br /> 3. k1 <br /> 4. p i <br /> 5. <br /> 7. to 14 <br /> 8. b fJMMr <br /> 10. �,(At� dWNti t <br /> Specific Date Range of Information Requested:From to <br /> �� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I�SINDERGROUNo TANK(UST)CLEANUP SITE(LOP) HORSING ABATEMENT 0-sluo WASTE FACIUTWEHICLE <br /> :' "HER CLEANUP SITE(NON-LOP) 000 FACILrTY ❑WASTE TIRE <br /> =RGROUNO TANK(MONMORINWREMOVAL) OG KENNEL M DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR _ HICKEN RANCH ❑WASTEWATrm TREATMENT PLANT <br /> U TIERED PERMITTED FACILITY d C 1 MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOIL <br /> ❑TATTOpISODY PIERCING ❑POOLISPALAND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FAGUTY t7 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC RECORDS ARE AVAILABLE:FOR REVIEW- MONDAY-FRIDAY 0:00 AMH6:00PM - EXCLUDING HOLIDAYS. _ <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 mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <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 file 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 expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 48-02.006 <br /> iM4ro6 <br />