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06/03/2005 10:00 916-37.' 09 RANEY GEOTECHNII PAGE 02/0 <br /> �r <br /> �Me�� ��II r NUMBER <br /> EU SAN JonQvuv COUNTY E <br /> ENVIItONMENTAL HEALTH DEPARTMENT <br /> iiiii 0 111) 7005 304 East Weber.AAvenue,3`d Floor,Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Tax:(209)464-0138 Web:WwW.Sjgov.org/chd <br /> ENWONMENT HEALTH 17105 <br /> PERMIMSERNES PUBLIC RECORDS RELEASE APPLICATION I <br /> APPUCANT: O L-ko-V^-"�,v&"—. BUSINESS/AGENCY: <br /> ADDRESS: LG�4a w l <br /> PHONE(1): 6 3 ` PHONE(2): <br /> FACSIMILE; <br /> TENTATIVE"APPOINTMENT DATE: '2 aoS Time: 0 to <br /> (Please allow 10 business days from 4ate bf application submittal-*Tentavve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQ ST =93.00 FEE WASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS NESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> UNIT DISTRIBUTION 0 Unit 1 M U nh 3 It 4 0 Unit 5 Unit 6 O Other(electronlclllsts/maps) <br /> FILE ADD EHD USE ONLY <br /> _. .. <br /> \, <br /> Street>K street Name City <br /> uST <br /> �! T �� .- r - <br /> z. L T <br /> C>72_1?$. C>72_1?iEl � �. .�. ��aC.l�'�"o th (AST <br /> 'j V v v 6. 1�/ - <br /> 8. ISM�� <br /> 9. Ahl .�...7 Orr, IF nksqz� F1 n <br /> � <br /> Specific Date Range of Information Raquested:From 1 4ici a to 4 �� ' <br /> // <br /> (_-fit• _ � _�- <br /> f/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NnEROROUND TANK(UST)CLEANUP SITE(LOP) �HOWING ABATEMENT t7A D WASTE FACRJr//YQNICLE <br /> PrHER CLEANUP SrrE(NON-LOP) ILI <br /> FooD FACTY WAgTE TIRE <br /> Mf DERGROUND TANK(MONffORING/REMOVAL) C DOG KENNEL 0 DAIRY <br /> OV ARDOUF WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TRPL <br /> EATMENT ANT <br /> ��WO TIERED PERMrrTm FACILrry 0 MOTELIHOTEL ❑PUMPER TRUCHPfARD/CHEM TOILETS <br /> 11 TATTOO/500Y PIERCING E3 POOLJSPA 13 LAND USE APPLKCAT1oN Srms <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE Fon REVIEW- MONDAY4RpnmY 8:00 AN Z:00pu - ExCLUDMG HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the fist 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 4842-006 <br /> 1ltd/a5 i <br /> %9Y <br />