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FEB. 8. 2006 9: 16AM CONT" EARTH TECH NO. 5527 P. 2/2 <br /> EHD LOG NUMBER <br /> SAN JO.A,QUIN COUNTY <br /> EN oNmENTAL HEALTH DEPARTMENT <br /> FFB — 8 2006 304 East Weber Avenue,3`d Moor, Stockton,CA 95202-2708 <br /> ')Telephone; (209)468-3420 Fax: (209)464-0)38 Web;www.sjgoy.org/ehd <br /> EWVIRO(NMEWT f-1EALTH 20131 <br /> PERMIT'r'RHES PUBLIC RECORDS ULEASE APPLICATION <br /> APPLICANT; HSA JC &( 1- BUSINESS/AGENCY: W r <br /> ADDRESS: ( �a �C (: R � - 4�i � �x�� 'a <br /> PHONE(1):-*9 43,+"05 IS PHONE(2): 209�< I$d7�'�_FACSIMILE:469-o4• "L)5'm <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from d of application submittal-'TentaVv only-must be confirmed) <br /> CHECK BOX TO EXPRE EST-$93-00 F ( H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS <br /> SIGNATURE OF APPLICA T DATE <br /> UNIT DISTRIBUTION D Unit 1 ❑Unit 2 Unit 3 ❑UM 4 C Unit$ O Unit 6 I= Other(electronicJlists/maps) <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. S6tJ ` <br /> 3. �, <br /> 4. p ( - iAla <br /> 6. �. <br /> 7. ILL a <br /> 8. 1 K _. <br /> cL. <br /> 10. 6V wlNtri r <br /> Specific Date Range of information Requested:From to <br /> ,,���// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I1UI+DERGROUND TANK(UST)CLEANUP Srm(LOP) HOUSING ABATEMENT m SouD WASTE FACIUTYNEHICLE <br /> a OTHER CLEANUP SITE(NON-LOP) COO FACILITY O WASTE TIRE <br /> UNDERGROUND TANK(MoMtTORtNG/REMOvAL) OG KENNEL Q DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR HtCKEN RANCH ❑WAsTEWATER TREATMENT PLANT <br /> l7 TIERI:D PERMITTED FACILITY La MOTEL/HOTEL ❑PUMPERTRUCKIYARD/GHem TOIL <br /> Cl TATTOO/UODY PIERCING ❑POOLISPA LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FAGUTY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 0:00 AM-6:00PN - EXCLUDING HOLIDAYS, <br /> I. 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 /> EHD 4e.o24% <br /> 1MN06 <br />