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SEP. 8. 2005 2:39PM ERP 'ACRAMENT0 N0. 662 P. 1 <br /> % 1W EHD LOG NUMBER <br /> L � DD, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 18[EALTR DEPARTMENT <br /> SEP - S, 2005 344 East Weber Avenue, 3r4 Floor,Stockton,CA 95202-2708 <br /> 11197 <br /> Telephone:(209)468-3420 Fax., (209)464-0138 Web:www.sjgov.ozg/ehd <br /> EfJVIRpN,viEIuT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE ,APPLICATION <br /> BUSINESS/AGENCY: t <br /> APPLICANT' <br /> ADDRESS: .48 <br /> � pnmc � <br /> a r 335` 432 b FACSIMILE: z of <br /> PHONE(1):ag. QZY 7� —PHONE(2): <br /> TENTATIVE'APPOINTMENT DATE W�e"�t di>Is• I l"�— _Tnna: <br /> (pleaallow 10 bwi�ess days from date of application submittal-'Tentative only-must be confirmed) <br /> 11 CHECK BOX TO EXPEDITE REQUEST-M-00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT AWAX APAA116 tivdDATE O p <br /> go <br /> UNIT DISTRIBUTION ❑Unit 1 O Unit2Unit Unit 0 Unit$ 0 Unit 6 171 other(electronl� tWm <br /> aapa) <br /> FILE ADDRESS EHD USE ONLY <br /> Street Mame city <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From !!t� to —b dk:� <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HousmG ABATEMENT 0 SOLID WASTE FACIUTYNENIcLE <br /> ER CtEAWuP SITE(NoN-LOP) 0 FOOD FACILITY O wAsTE TIRE <br /> DERtiROU ID TANK(1410 0RINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> WasTEGt NERATOR L]CMICI(EN RANCH ❑WASTEWATER TREATMENT PLANT <br /> EFED PERMITTEn FaCILRY O MOTELIHOTEL 0 PUMPt:R TcsucK/YatD/CNeb TaIFTs <br /> Q TATToo/BODY PIERCING 17 POOLI`'PA M LAND USE APPuCATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE-SPECIFY) <br /> WEE AND SEPTIC PERw RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 A 4-5:OOPM - 1-=XCLUDING HOUOAY3 <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 /> i <br /> Flo as os-ous <br /> IM4MS <br />