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DA����{v� SAN JOAQTJIN COUNTY <br /> M ED �J EHD LOG NUMBER <br /> llllii ii11� <br /> �c::..�� <br /> NOV 2 0 2006 ENVIRONMENTAL MALTH DEPARTMENT <br /> 304 East Weber Avenue,311 Floor, Stockton,CA 95202-2708 <br /> ENVIRONMENT HEALT"epbone:(209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd 4 g I <br /> PERMITMWICES PUBLIC RFCORDS RELEASE APPLICATION <br /> APPLICANT: &Ll'61. PeUAr/ BUSINESS/AGENCY: GTlC t h�� _ <br /> ADDRESS: .?008'5 1V0r,- 1z aLj <br /> y ��IQC of h5Z,, �/� 9 .�3 Q <br /> PHONE(1): y15"lode` ln_ Y j� PHONE(2):�ox� �?SO":5� FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Ia2 be*/,olo Time: l/) tfM <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be conflmled) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT k sia,L�; / /,.� 7�— DATE <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name City ❑ Unit 1 <br /> �. Jac <br /> 'v f / El Unit 2 <br /> 2. 14.2 <br /> 3. 51 <br /> Unit 3 <br /> 4- <br /> 5. <br /> Unit 4 <br /> 6. <br /> 7. ❑ Unit r, <br /> 9. D Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> r ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ix+UNDERGROUNb TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOYAL) 0 DOG KENNEL 0 DAIRY <br /> TA2AR000S WASTE GENERATOR ❑CHICKEN RANCH 0 WASTEWATER TREATIAENT PLANT <br /> IERED PERMITTEb FACILITY 0 MoTEOHOYEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOL/SPA 13 LAND USE APP ICAYtON SITES <br /> V MEDICAL WASTE FACILITY �THER(PLEASE SPECIFY) WL rl Ori <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REviEw- MONDAY-FRIDAY E:OD -5:OOPM - EXCLUDING HOLIDAYS. <br /> 1. Last up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the add ss indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> 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 application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by 9HD staff at the expense of the applicanL <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD40-06 WISP-006 <br /> TO 39Vd Hd 9NId33NI9N3 DI13 OZLVZ09SZ61 SO:ZT 900Z/0Z/TT <br />