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�Cl <br />0 Wit <br />10/02/2008 10:17 FAX <br />Z001/001 <br />DA I �, ' � `—' EHD LOG NUMBER <br />r LID) <br />SAN ,1QAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />OCT 2 2008 600 East Main Street, Stockton, CA 95202-3029 V <br />Telephone; (209) 468-3420 Fax: (209) 464-0138 Web. www,sjgov.org/ehd <br />G_:NVIRONMis NT HEL:At_T�i <br />PFRMJ/ 1MVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �S YL_ I na :tt I►, leY <br />ADDRESS: _ !UI I STY P <br />PHONE (1): 1 <br />/ PHONE (2)- _ <br />TENTATIVE" APPOINTMENT DAT <br />(Please allow 10 buslnes4 day fro dabs of <br />0 CHECK BOX TO EXPEDITE R QU - O6 FEE C <br />SIGNATURE OF APPLICANT <br />BUSINESSIAGENCY: ? 1 M kto v <br />Cltylsta <br />►P <br />50 1)06q FACSIMILE j (n 1 I Gl� <br />Time: <br />submittal -'Tentative only - must b confirmed) <br />ONLY) -REQUEST PROCESSED INS BUSIN5S DAYS <br />DATEos <br />Electronic Information: ❑ List Map -- Descript on; <br />FILE ADDRESS EHD USE ONLY <br />S(root # <br />Street Name <br />city t 1 <br />0/1 <br />a 5 <br />� I, I-hn) '06—, �/NOLQfil� Unit <br />N lir <br />I/voun'� f 3�rj �10000 IUOCJ(S unit S <br />;,, Unit 4 <br />2�C� oEy,,vc; co% <br />06 c0�> <br />U -5-9—P Units <br />a U�iT� Ff�, �E�, NOC(1 Unit6 <br />1. <br />2.Tza <br />3. <br />�l�v <br />4. <br />5, <br />6- <br />2 <br />7. <br />1 <br />g. <br />9. <br />Specific Date Range of Information Requested: From I q 10 1 to � e in <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES �l'I I(S <br />tiz-.FHE, <br />GROUND TANK (UST) CLEANUP SITE (LOP) E3WHOUSING ABATEMENT LID WASTE FACILITYWEHICLE I a g,`VCLEANUP SITE (NON -LOP) Q FOOD FACILITY TE DREe jGROUND TANK(MONITORING/REMOVAL)y ❑DOG KENNnI���AIRYDOUS WASTE GENERATORPC 11 CHICKEN RANCH STEWATER TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ZcKiMPER TRUCK/YARD/CHEM TOILETS <br />0 TATTOO/BODY PIERCING ❑ POOL/SPA P14ANo USE APPUCAT10N SITES <br />❑ MEd CAL WASTE FACILITY ff) OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FR)DAY 9:00 AM-6:010PM - EXCLUDING HOLIDAYS, <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 (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 avallable. <br />4. Any file not returned In the gams 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 />o IUQ. CrA,1n+Q1'W_C e— ze <br />EHD 4"G 8/04108 PU9LIC RECORDS RELEASE APP FORM <br />