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1234 KLEINFELDER 11:22 12-03-2010 1/1 <br />v., <br />I" nCt,r_f :cu 0am''_ w�\1M EHD LOG NUMBER <br />�``P <eqy" SAN .10AQUIN COUNTY <br />�f <br />.� ENVIRONMENTAL HEALTH DEPARTMENT <br />*1 600 East Main St. Stockton, CA 95202-3029 <br />Telephone; (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION -Y"-(W t-- <br />QPLICANT: <br />14Q BUSINESS/AGENCY: <br />C VVRESS: <br />CITY/STATE/ZIP: <br />PHONE 1, S" - PHONE (2):_ FACSIMILE:_ 67 <br />LKI <br />P °M�v s'a�, - ra I/ ase APPOINTMENT <br />ow 10 bu MeN d days <br />TE: Time. <br />from dat f applicatlon bmittal - `Tentative only ---must be confirmed) <br />CHECK BOX TO EXPEDITE REQUEST - $122 FE C SH OR CH K ONLY) - REQUEST PROCESSED IN 3 13USINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />Electronic Information: ❑ List ❑ Map - Description: <br />FILE ADDRESS EHD USE ONLY <br />Street # Street NameCity - n6 (� 5 ❑ Unit t <br />� <br />C✓� �tV" <br />2.n <br />--Unit 2 <br />4.�� <br />nit 3 <br />s. V75o� _ �cc f1� _ _ �,Q - — / <br />�N� �� (° VST• nit 4 4 <br />9. 1T --s&— .—. _ ❑ Unit 5 <br />' <br />Specific Date Range of Information Requested: From <br />I � <br />(��p(1[_ <br />Ll Unit 6 � <br />to CVr�'�- <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />ROUND TANK (UST) CLEANUP SITE (LOP) El HOUSING ABATEMENT <br />Prioq�=DiR-CLEANUP <br />❑ SOLID <br />�*IJ�r <br />WASTE FACILITYN <br />I/^'EHICLE <br />I <br />SITE (NON -LOP) <br />�ltV�,�NNDDE�ERGROUND TANK (MONITORINGIREMOVAL) D( <br />0 FOOD FACILITY <br />EliDOGKENNEL <br />❑ WASTE TIRE <br />❑ DAIRY <br />J <br />[7J A RDOUS WASTE GENERATOR a <br />❑ TIERED PERMITTED FACILITY <br />0 CHICKEN RANCH <br />❑ MOTE] <br />❑WASTEWATER TREATMENT PLANT <br />) z_ 7- 10 <br />❑ OO/BOGY PIERCING L-AEl <br />I RUCKITARDICHEMICAL TOILETS <br />TATT <br />-�,TATT ❑ POOL/SPA ElLAND USE APPLICATION SITES <br />Ea rEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. List un 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 (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 $122 deposit prior to review. <br />EHD USE ONLY <br />107 5F rn a <br />La SL5t o ��OS <br />( 11 /UtzU <br />Lb ()�gDq, (f) ()7-jA5�. (�nn— q U i aU I� i(nrc�d 00 N <br />EHD 4846-- 11;711 <br />07129110 <br />pzI151 <br />