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09/25/2007 08:51 FAX 5307585672 PEDEX KINKO'S DAUIS U002/003 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.ojhd (113 <br /> PUBO Aj <br /> LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �E�rll S - /" Ste 0 f- BUSINESS/AGENCY: COA.5'd L a", -& <br /> ADDRESS: cd el \ k u <br /> PHONE �58- 3 PHONE � 3� 6) 902'063Z FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confl <br /> CHECK BOX TO EXPEDITER QUEST-$96.00 FEE(CAS HECK ONLY)-REQUEST PROCESSED IN 3 S il <br /> A <br /> NATURE OF APPLICANT DATE Z <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City ❑ Unit 1 <br /> A m,5frana RCL <br /> Lodi' n�5— Z-1 <br /> 2. <br /> rL& <br /> n,(. c nf'ol� oa-e 9�o6 L ad i l bio- <br /> W. Sa.f en 3 -- -1-0 <br /> t� -r- -Mv S <br /> ❑ Unit'3 <br /> �k Unit 4 <br /> �, /)2:r 5+tend TZ�C L ecLc N4 6 <br /> 7•v 'rowi, /UO ❑ UnitS <br /> a 5/ Oz i4 i �� �< UP 9f-a9 -79'-o4,9Z-2M;9i-/d,$ of-SU, <br /> 9. 2-Ll Lo 1-o ❑ Unit 6 <br /> OV-1/ Ar Rid 1��9 I_Od( M6 92-d 9 �A 9 7—,56" <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 1❑HOUSING ABATEMENT 17 SOLID WASTE FACT <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑WASTE TIRE <br /> I s N <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) 0*T.ER <br /> L ❑DAIRY <br /> 13 HAZARDOUS WASTE GENERATOR NCH 0 WASTEWATER TREIE;V <br /> ❑TIERED PERMITTED FACILITY EL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOo/BODY PIERCING LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ASE SPECIFY) <br /> WELL AND SEPTIC PERMIT O A AVAILABLE FOR REVIEW -MONDAY-FRIDAY 6:00 AM-5:0OPM -EXCLUDING HOLIDAYS. <br /> IF <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(209)464.0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> - days after receipt of application.-The files will be field fora maximum of five-business days for review.-Appointments <br /> s ti o uldU,es chedu lei according Ly- <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new app Icat o'—m y15e <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$98.00 deposit prior to review. <br /> END USE ONLY <br /> EHD 48-08 WEB &2W7 <br />