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�/16/z006 10:58 FAX "- EM 002/002 <br /> DATE=RECEID E <br /> GE <br /> �/] 'A J4A jTI1� C EHD LOG NUMBER <br /> ll �NvmONMNTA L MALTH D <br /> ARTMErrr � <br /> {}4 East Weber Avenue, P Floor Stockton, CA 95202-2708 <br /> JAN 1 �' �`L � �, ; <br /> ep one:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.orgfehd <br /> ENVIRONMENT HEALTH <br /> MIT SERV12tJBLIC "CORDS RELEASE APPLICATION <br /> APPLICANT. <br /> SUSINESSIAG':ENCY: <br /> ADDRESS• �"ZS� - <br /> CITY To C�� <br /> S W. - STATE. C -- <br /> PHONE(i g� ( y� PHONE(2�- FACSIMILF_ ` <br /> TENTATIVE*APPOINTMENT DATE: (o Time- <br /> (pl9d &allow 10 business days from daft of applicadon submrdW-`TantaHve only-must be canfirmitd) - <br /> CHECK BOX TO EXPEDITE REQ T-$93.00 FEEH OR CHECK ONLY)-REQUEST PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE { <br /> Electronic p Llst ❑ Map <br /> Infannatton p-Description <br /> FILE ADDRESS EHD USE ONLY <br /> 8131St F Street Name City <br /> YA4 p1 <br /> 2. L I cjz� r, ❑ Unit 1 <br /> 4. i� Unit 2S <br /> 5. Unit 3 <br /> 6. <br /> Unit 4 , <br /> 0 Unit 5 <br /> ��• Unit 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH:DEPARTMENT FILES <br /> eUNDERGROUND TANK(UST)CLeaNVP SITE(LOP) Q HOUSNO ABATEMENT 'M SOLA WASTE FACILITY1VEI41CtE <br /> OTHER CLEANUP SItE(NON-LOP) 13 FOOD FA09M C3 WASTE TIRE <br /> dKUNOERGROUND TANK(MORrIlORINGMEMOVAL) E3 DorKENNEL DAIRY <br /> Z I­IAZARDOUS WASTE GENERATOR C7 CmrumN RANCii "ASTEWATER TREATMENT"PLANT <br /> E3 TIERED PERMITTED FACaM 0 M0IELIHOTEL C]PumpeR TRucKr(ARDICNenrAL ToLuTs <br /> M TATTOOIWI Y PIERCING ❑POOLISFA )Q LANs USE APPL1CATKM Sliss <br /> E3 MEDICAL WASTE FACILITY O OTMER(PLF.ASESPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 Ale 3:00PM - EXCLUnme HOUDAYS. <br /> 1. List up to ten addresses In the space above, Select the type(a)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selaeted. Fax to 12091 ►64-0138 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 notlfy 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 maxinnurn of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked 4n by EHD staff may not be Immediately available for review. A new <br /> application maybe submitted when the file is available. , <br /> 4. Any file not returned in the asame condition as released will be motVanlzed by EHD staff at the expenee of the <br /> applicant. Future file reviews by the same applicant may require a$83.00 deposit prior to revia"w. <br /> ,aro sac <br /> 14f.11J2006 <br />