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_---U/18/2006 10:59 FAX to R 002/002 <br /> DATE RECEIVED EHD LOG NUMBERGD E—j'F�Y F 4NVIRONMENTAL HEA THD TMENT <br /> JAN 1 " Q( (East Weber Avenue, Yd Floor, Stockton, CA 95202-2708 <br /> ep one: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov_org/ehd <br /> ENVIRONMENT HEALTH <br /> PE U MiT SERVI(PUBLIC RECONS RELEASE APPLICATION <br /> APPLICANT:— &�A-1*.) M05,102 BU^siNESSiAGENCY: <br /> ADDRESS: GfTY STQ -�i / STATE, <br /> PHONE(1 �}1 -1�{S-" t��� PHONE(2): FACSIMILE` <br /> TENTATIVE"APPOINTMENT DATE: Time: i L _ <br /> (Please allow 10 business dap from date of application subrnnW-7entatrve only-must be confirmed) O <br /> © CHECK BOX To DCPEOrrE RE uEsT-;93.00 FEE LC4kSH OR CHECK ONLY)-REQUEST PROCESSED IN 9 BUSINESS DAYS G <br /> SIGNATURE OF APPLICANT DATE I 1r Off_ 8 <br /> Electronic <br /> InlnrtnsInformation ❑ Llat C3Map-Descrfptlon <br /> FILE ADDRESS djj 5EHDE ONLY <br /> Stretat aF Street Name city <br /> 1. Qi <br /> z. <br /> � ) Unit 1 <br /> 3. I coyf Unit 2 S <br /> 5• Unit 3 <br /> 6. e, Unit 4 <br /> 6. <br /> 1 <br /> 99d Unit 5 <br /> . <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> bf UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑Houswa AeAmmENT 19 SOLD WASTE FACILITYIV MOLE <br /> %OTHEIR CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 WASTE TIRE <br /> i moERGROUND TANK(MONITORiNGIREMOYAL) 13 DOG KENNEL DAIRY <br /> ZI HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTEIJHOTEL O PumPER TRUCKrfA9D1CHEMK:AL TOILETS <br /> ❑TATT001BODY PIERCING ❑POOLISPA )q LAND USE AprucAvm Stm <br /> O MEDICAL WASTE FACILITY O OTHER(PI EA C SPECK _ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAR AISLE FOR REVIEW-MONDAY-FRIDAY 8:00 A!d-S:OOPM - EXCLtiomo 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 46"138 or mail to the rtddress <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 EHp 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 expanse of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> END 4" <br /> 10/]1/2006 <br />