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03/16/2007 15,:10 FAg -- -. Q002 <br /> R�M11N <br /> EHd LOG NUMBER <br /> ��; SAN JOAQUIN COUNTYI <br /> ENVTiRONMENTAL HEALTH DEPARTMENT <br /> MAR 1 6 2007 304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRCN[0ENT hEALi HZP4 1 <br /> PERMlTiSERV10ESPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: lc V,&ik -50:n Vr, BUSINESS/AGENCY: Wal} ,,-K.,4A1 to seGiaT�s <br /> ADDRESS: 3y1C) i,t)•I',rW-P%er ulC 5 ci<�o �5 <br /> PHONE(1): 2a Z3 4_. -h PHONE(2): 2�S`1234-7727 x <br /> TENTATIVE*APPOINTMENT DATE: !{ Time: <br /> (Please allow 10 business days from date of application submittal-"Tenfadve only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE RE T•IRS 00 FEE(CAS OR EC ONLY)-12EpUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ ;i DATE V16/07 <br /> Electronic lnforrnat(on: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 unit 1 <br /> 1. 315,1 Wr-+er toe p� 5�vck av, <br /> `Z <br /> 3�F '1t q �ve RAS ❑ Unit 2 <br /> 3. q q 07 tjOA-"3o 0 94 E L- <br /> 4- f/A+n <br /> E y` �I <br /> T'e. 1od Rj Unit 3 <br />! 5• <br /> 175 5 IQ Br-e0LJQ0,y <br /> 6. ltnR4V <br /> 7. je6 4 00 tj P-0 4Z r, `S+a G n p gun 5 <br /> a <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK;(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SrrT(NON-LOP) 13 FOOD FACILrnr 0 WASTE TIRE <br /> UNDERGROUND TANK'(MONrroRINGIREMOVAL) 17 DOC,KENNET. 0 D/URY <br /> HAZARDOus WASTE GENERATOR ❑CHICKEN RANCH M WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL M PUMPER TRUCKfYARD/CHEM TOILETS <br /> TATTOolBODY PIERCING d POOLISPA 17 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) 1' <br /> WELL AND'.SEPTIC PERMr r RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 Am-5:00PM - EXCLUDING HouoAYs. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to L209)464-01_38 or mail to the'�address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses corntact the EHD.Applications received after <br /> 3:40 pm will be processed the next business day. <br /> 2. The EHD will not the applicant if an EHD files exist. An Hy pp Y appointment for review will 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. r <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 /> �I <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$95.00 deposit prior to review. <br /> i4 EHD USE ONLY <br /> EHD 46-06 9!1312005 <br />