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,h> '"r' �Pa. ''IS£+b`Sr +> •`` S. lt�' <br /> X41 ': <br /> .. �.+i 1 -^ Ij 1, ,. .. . . z- : .>�1mmwA+ • n Y7,'v',-:. <br /> SAN JOAQL TN COUNTY g <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 1 1 2005 304 East 'Weber Avenue, 31`d Floor, Stockton,CA 95202-2708 � ��� <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web: www4gov.orWehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �'n5.e.1 Ar Q�4h BUSINESSIAGENCY: <br /> ADDRESS:_. Z� �)W�-'kyl Qs, I T'ur�a�}C CP e(r'S't1 t <br /> PHONE(1): PHONE(Z): 247 FACSIMILE: LST 46'}_4C,6(g <br /> TENTATIVE`APPOINTMENT DATE: 6 Time: 09Ql� <br /> (Please allow 10 business days from data Of apiplication submittal-•Tentative only-must be confirmed) <br /> Cl CHECK BOX TO EXPEDITE REQUEST-$`90.00 FA..E CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 USINESS DAYS <br /> SIGNATURE OF APPLICANT ��w V-�l, ` DATE 0�` <br /> UNIT DISTRIBUTION ❑Unit 1 ❑Unit Z ❑Unit - Unit ❑Unit$ ❑ Unm 6 ❑ Other(electronidlistsfmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Stmet R Street Name city <br /> d4. <br /> IaLA CA S tN.c.., s� ' LK 2.21BS EFrc +o�* 54 $.OT-1 o Mta.,A a i S t.K ^Co 1 S rc,c 1� <br /> 8. l� o rn lTa CK •� yyl <br /> yv <br /> 10. 1 zl3't e• Mart o yed S G <br /> Specific Date Range of Information Requested:From Za43 to Cy prt .4- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) ❑ HOUSING ABATEMENT ❑SOLIDWASTE FAmUTYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD 6c1uTY Cl WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> aM INIMAQUIS WAXTE GeNO TOR Z04"alaal4NA#MH d AvomewATeR T11Nr1Ae 4%*M <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTODIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACaITY ❑OTHER(PLEASE SPECIFY) <br /> WFIL ANDSEPTIC PERMIT RECORDS ARE AVAILABIP FOR RENEW - MONDAY-Fra GAY 8:00 ANd:OOPM - 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 b'e 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 applicAcin. 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 stal 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 11-024% <br /> 111"s <br />