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e5i01/2007 16:46 GEOMPSX-RANCHO CORDOVA d 12094640138 NO.753 1;02\ <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JoAQuuv COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E. Main.Street, Stockton,CA 95202-Mq7Z <br /> NT <br /> (209)468.3420 Fax:(209)464.01.38 Web:www-sig g e <br /> /y <br /> PUBLIC f � r�RoEC�ORDS RELEASE APPLICATI�ON <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: W ( L '?—c CXD-nvA, G 5µGP�l4PHONE(1) WnFACSIMLE:%l�-,'L!IiC �GqJTqIS^y <br /> 1Tu,Y1'` „7 <br /> 320 <br /> TENTATIVE`APPOINTMENT DATE: A64F Time: <br /> (Please Allow 10 business days from onto of application submittal•'Tentative only•moat bo confirmed) <br /> `/I�i/CHECK BOX TO F]PEOITE RE/q{!/QST•$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS <br /> SIOHATURE OF APPLICANT/ 'sem DATE / b <br /> Electronic Information: 0 List El Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street a Street Name city OrUnit 1 <br /> 2. /11mt 2 <br /> 3. Unit a- <br /> 4. <br /> 5. <br /> Unit A : <br /> 6. Wity <br /> 7. <br /> UsUnit <br /> s <br /> 8. <br /> 9. Unit 6 <br /> 10. <br /> Specific Date Range,of Information Requested:From 0 _ _ to _W py—r::;1yT <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Im UNOEROROuNO TANK(USTI CLEANUP SITE(LOP) wIOUSINO ABATEMENT 'M SOLID WASTE FAC1LRYMHICLE <br /> '19 OTHER CLEANUP SFIE(NON-LOP) "F.Pmu FACILnY -WASTE TIRE <br /> �9 UNPEROROUNa TANK(MONnORINOIREMOVAL) `Q DOG KENNEL .DAIRY <br /> -'ID HAZARDOUS WASTE GENERATOR '-CHICKEN RANCR "Q WASTEWATER TREATMENT PLANT <br /> �G ' <br /> TIERED PeRmmneD FACILITY MMOTELMOTEL `;LPUMPEKTRucidYARD1CHEM TOILETS <br /> -CLTATToO/Boav PIEBCINO NPPOOUSPA �LAND USE APPLIGNTION S7E3 <br /> �Q MEOICAL WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Rt:1M - MONOAY-FRIDAYS: •6:0OPa . EYCLUNUGHOLMAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of Hies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0139 or mall to the address indicated abov_e_= Address <br /> ranges Will nut be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pen will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD flies exist. An appointment for review VIII 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 an by EHO 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$85AM deposit prior to review, <br /> EHD USE ONLY <br /> EHe/Bae§nA'Aaee wb <br />