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NOV-4-2009 11:44A FROM:GEOPHP 9NV 2095690295 - 1640138 F•2 <br /> ----^ORTE RECEIVED SAN E LO NUMBER <br /> (� I� <br /> ENVIRONMENTAL HEA <br /> COUNTY LTH DEPARTMENT <br /> 600 Fast Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> /� <br /> NOV 0 4 X009 <br /> ENIVIIRON PUBLIC RECORDS RELEASE APPLICATIOO_NY <br /> PE <br /> E /II+I.0 ��/ 'M a BUSINESS/AGENCY 6:iW ~re v <br /> ADDRESS: bys4 zo^, �M I+'rA / -& - CltylSJtatel2lp p� _ <br /> PHONE(1): T&-g, aK� PHONE(2): lu;rr OIZ9. FACSIMILE: fi 0 95 <br /> TENTATIVE APPOINTMENT GATE: / f j'0 Time: <br /> (Please allow 10 buif appli etlon submittal-'Tentaflve only-must 6e confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REOUE T-Stab FEE(CASH OR CHECK OILY)-REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �� 9 <br /> IF <br /> Electronic Information: ❑ List❑ Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Sheet x _ Street Name _ City_ Unit 1 <br /> " <br /> S/Vt 2. GGA 41-c-1- 14440;yla7y�v,D y <br /> ❑ Unit 2 / <br /> 3. i <br /> t3 <br /> 4. <br /> 6. Unit 4 <br /> 6. <br /> 7. ❑ Unit <br /> 8. <br /> g. ❑ Unit 6 <br /> 10, <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> VNDERGROUNo TANK(UST)CLEANUP SITE ILOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑WASTE TIRE ' I I , <br /> DERGROUND TANK(MOMTORINwREMOVAL,K�/�/ 0 DOG KENNEL 0 DAIRY (iVI I <br /> ` OCHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> •TIERED ER WASTE FACILITY <br /> aC II/(/�/D <br /> O TIERED PERMITTED FACILITY ❑MOTEL/HOTEL �PUMPER TRUCIUYARD/CHEM TOILETS <br /> O TATtOOIBOOY PIERCING 13 POOLISPA O LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACIUTY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVALLADLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space abovo. Select the type(s)of files from the Ilet 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 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 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 on by EHD 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$106 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48.06 W04)08 PUBLIC RECORDS RELEASE APP FORM <br />