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From: 08121 7 17:07 6:29 P.0011001 <br />2094640138 ENVIRONMENTAL HEALTH <br />SAN JOAQtMq COUNTY <br />AUG 2 2 2007 ENVMONMMENTAL H- E LTH DFPARTMF.NT <br />600 East Main Strcct, Stockton, CA 45202 <br />ENVIRONMENT HEA D+elephone: (209) 468.3420 Fax: (209) 464-0138 Web: www.sjgov.o <br />PERMIT/SERVICES <br />2BLIC RECORDS RELEASE APPLICATION <br />APPLICANT: 1. Y', , iv1. BUSINES$IAGENCY• <br />PAGE 01101 <br />Eid LOG NUMBER <br />t <br />ADnRESS, 0 4 4, t N OC-, 2S "( <br />PHONE (1j _0�7 J ` .� `%} ): �� i.�"` D ti S ?d IN <br />TENTATIVE` APPOINTMENT DATE.- rime: <br />(Please allow 10 Malrle3S (14% from date of application submittal - `Ter fft only - must be confirms <br />CHECKBOX TO EXPEDITE REQUES IG�ATURES9 Q PESE(.H CiiECK ONLY) - REQUEST PRoeriwSSED iN 3BUSINESS DAYS <br />SIQ d <br />F APPLICANT DATE <br />Electronic Information: Q List I] Map — Description: <br />street # <br />MILE ADDRESS _ Street EHD USE ONLY <br />_ <br />6 _ 6 0 G , e _..... YiAnz- u �l//l <br />13 Unita <br />.f67r- / A t <br />l�_ 6 <br />4 Nie ,-A,�7 <br />(�I Unit d <br />_ t <br />:. 6 Lf 4Ar, <br />Erb cs _ 8" ° t C-® iA �•C.1 _ ® It, '-at ® unit 0 <br />72s�;� f N G f <br />Specific Data Range of information Requested: From to <br />DUENVIRONMENTAL HEALTH DEPARTMENT FI S <br />ERSIMUND TANK (UST) CLRANuP StrE (LOP) 13 HAVING ABATEMENT to WASTE PACA.1 <br />� CLEANUP srce (Noxi-LdP) o FOOD FACILITY . TE T <br />UNDEFtGROUNo TANK (MoNn'=RwdI�MOYAL) 13 Do* KENNt:6 DAIRY <br />`b L7 I IAZAWDOU3 WASTE GENERATOR © CHICKEN ❑ WASTEWATER TREATMENT PLANT <br />r �V TIERED Pt tuAYrTEO FACILITY O MOTEL41 Cl PumrAR TRucKiYARD/CHam To Lr;TS <br />Li TATTOOiHODY PIERCING 0 PCOLlSPA © LANG USE APPLi noN SiTES <br />MEDICAL WASTE FACILITY 0 OTHER {PL . SIE SPECIFY) <br />WELLAND SEPT1C Pr.RMrrRECoRDs ARE AYAR,ARLE FOR RFvMW - 11110NDAY-FRIDAYS.D0 AM-"DPm - EXCLWING f(Qi,IDAYA. <br />1. List up to ten addresses in the specs above. Select the types) of filar from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (2091464.0138 or mail to the address indicated above Address <br />ranges will not be gocepted— for additional assistance with file addresses, contact the EH0. Applications recelved after <br />2:00 pm will be processed the next business day. <br />2. The FHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The Eales will be held far a maximum of five business days for review. Appointments <br />should be scheduled accotdtngty. <br />3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br />submitted when the file is available. <br />Q. Any file not returned In the same condition as released will be r®organized by EHD staff at the expense of tate applicant. <br />Future file reviews by the same Applicant may require a $95.00 deposit prior to review. <br />EHD USE ONLY <br />