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mil <br /> Y <br /> SAN" I <br /> 01 <br /> Al 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 368 East Hazelton enue, Stockton, CA 95205-6232 <br /> ne 2 =3 X63-3420 : (209)464-0138 Web: � .Sjc rrg1e�T <br /> ENVIRONMENTAL .PE1 'S1E APPLICATION49H <br /> PUBLIC RECORDS RELEASE <br /> APPLICANT: BUSir A N : w <br /> ADDRESS: KK lr<. TYIT `rE114' '` " <br /> PHONE± 1): , �j ...._._ PHONE 2). )S74 U,5, 0 FACSIMILE: t <br /> E <br /> L k q w p es e allow 1 tU mess days fro s date of application sL� litts for the records sal <br /> .` Staff it contact e srslte sly prep to slid time t reviewthe rLles re r <br /> CHECK BOX C)EXPEDITE ITEC E T p'$12E F E(CASH OP CHECK ONLY)-REQUEST PROCESSED IN,° B �-VIS [LAYS <br /> SidNATURE OF APP I :AI . <br /> �iectrnl I�rfcarnatl�ans List�Iill IeSr►ltlrn° ;� � " "�" � � �,�� ' .�� '� �'� f`# ,..% <br /> FILA � Ert tip taNLy <br /> E <br /> 4• _ ( Unit a, <br /> ..� �..� Coati ?& <br /> q.; <br /> 9. <br /> M Unit 9 <br /> Specific Date Range of Information Requested* Frcarra to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES .� .. <br /> N RCRLtUND TANK(LIST) I EAI�UP SITE(LOP) MEDICAL TASTE FACIL �SOLID ATE FACILITY1 E TCL E <br /> THER CLEANup SITE(NON-LOP) HOUSING aING ABATEMENT WASTE TIRE <br /> rrERG1ROU t TANK MITNIT IN 1 E vAL) FOOD FACILITY [:1 DAIRY <br /> IA"BOVERROUND TANK CHICKEN RANCH/DOG KENNEL 0 WASTEWATER TREATMENT PLANT <br /> � <br /> fiAZARDOUS'WASTEIHA7ARDOUSII MATERIALS 0 MOT LJHTEL E:]PUMPER PER TRUC ARDI HEM CAL TOILETS <br /> TI RED PERF ED FACILITY P OLISPA [:]LAND USE APPLICATION SITES <br /> Ej TATT001130DY PIERCING om LAINTII ESPONSE RECORDS E]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT REcORDS ARE AVAILABLE FOR Evteiv: MONDAY-FRIDAY 8:00 M- :000 (EXCLUDING HOLIDAYS) <br /> #. List a tca ten addresses In the space above, Select the type(s)of files from the list agave by checking the appropriate <br /> box(es). At least erre file type MUST be selected, Fax to 2091464-0138 or mal to the address indicated above. Address <br /> ranges will not be accepted.Applications received after :00 prn will be processed the next business day. <br /> 2, For assistance In identifying the nature and content of EHD records,Blease contact EHD at the number nested above. <br /> 3. The EHD will notify the applicant if any EHD files eist. An appointment for review will be confirmed approximately tart 10) <br /> clays after receipt of applicatlear , The files will" d held for a maximum sof five business days for review. Appointments <br /> hould be scheduled accordingly« <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$125 deposit prior to review. 'BOXED AREA-EHD-EHUSE ONLY*� <br /> er pvlect �t � rnitete. ttt a , : <br /> END 48.06 4128114 <br />