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PEVAM Ad `iced GeoEnvironmental0 9�. , EHD L����UMBEFt SAN JOAQUIN COUNTS <br /> ENVIRONMENTAL HEALTff DEPARTMENT <br /> SEP - 1 2005 304 East Weber Avenue, 3'd Floor, Stockton,CA 95202-2708 007 <br /> � <br /> ENVIRONMENT HEALT�lephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov_org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <) n On BUSINliSSlAGENCY: Wodmcffb wU. <br /> ADDRESS: b a S.`iM C15-21 <br /> p <br /> PHONE( - 01-106 PHONE(2): 01 p 7 ' I Irl r �/!�, FACSIMIEE: Q140- <br /> _71 <br /> 4 7` - <br /> "APPOINTMENT DATE: D a6 -�-� Chi"G(I/W,(/` <br /> TATNE APPOINT �, l ,_•� a� Time: /!� <br /> (Please allow 10 business days nom dAe of application submittal-'Tentative only.mW be confirmed) /1 n <br /> CHECK BOX TO EXPEDITE!=00 (CA$ CHEC NLY)-REQUEST PROCESSED IN 313U IN S DAYS SIGNATURE OF APPLICANT DATE / Q <br /> UNIT DISTRI6UTION ❑ Unit 1 15 Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ other(electronic1119tslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street II Sjreet N me city <br /> �. CIO 0 <br /> 2. <br /> 4, arrA lditCrl� <br /> 5. <br /> B. <br /> 7. D aL C <br /> 8. 33 anal L <br /> 8. � <br /> 10. <br /> Specific Date Range of Information Requested, From _ _ .4 117AE <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) tl HOUSINa A9ATENENT ❑SOLID WASTE FACILITYIHEHICL <br /> OTHER CLEANUP SITE(TION-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIRIEMOVAL) In Doe KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICI<EN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMnYEb FACILITY ❑MOTELIHOTFL ,(�UMPER TaUCKIYARIVCHEM TOILETS <br /> 0 TATYOWBODY PIERCING 171POOLISPA �yI AN0 USE APPLICATION SITES <br /> 13MEDICALWASTEFACILITY ❑OTHER(PLEASE SPECIFY) / <br /> WELL AND SEPTIC PERMIT RECORDS ARE AYAILAELE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDING HOODAY6. <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(2091464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted-for additional assistance vlrth 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 /> .y <br /> Y. <br /> ,,,���{{{ 41 _ `ice``,`✓F ... <br /> EHo 4"244 <br /> 1114W6 <br />