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e. <br />11/30/2009 11:54 FAX <br />00102/002 <br />EHD LOG NUMBER <br />NOV 3 0 ZOU9 ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />E��j�UNiU�Rvt.jrh'one: (2D9) 468-3420 Fax: (209) 464-0138 Web: Ywvw,sjgov.org <br />PERMCT� PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: PSIS BUSINESS/AGENCY:C. <br />ADDRESS: '34�9 I vE CITY/STATEOP: SAc��� Cr4 cis �l <br />PHONE (1): eW6 qYc> --OZ'S'-{ PHONE (2): 0 /16 FACSIMILE: l� t4po •-0 603 <br />TENTATIVE"APPOINTMENT DATE: Y/o9 Time: OSC]o <br />Fr(Pie ass allow 10 bucinese days from date of application submittal - •Tentative only - must be confirmed) <br />CHECK BOX TO EXPEDITE REQ15 F (CA OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESSDAYS <br />SIGNATURE OF APPLICAN DATE (I /S0/of <br />Electronic Information: <br />❑ Lis Map — Description: <br />❑ POOL/SPA <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />FILE -ADDRESS <br />EHD USE ONLY <br />I ■ <br />Street # <br />StrNt Name CityIle; <br />0 Va$ t . <br />1• <br />Sy t <br />too <br />)6s�1 juQ <br />- <br />2. <br />. <br />U 0 rn 1?6 <br />" <br />/ <br />2 <br />3. <br />5 W , <br />-T� <br />07-) ob <br />4. <br />W <br />L -I <br />O �`� ,�Il CO , <br />Unit <br />L_ <br />Unit 4 <br />9. <br />7. <br />❑Unit 5- <br />8. <br />❑ Unit 8 <br />10. <br />uC*4- From"' <br />Specific Data Range of Information R17F <br />ENVIRONMENTAL HEALTH DEPARTMENT FILE8 <br />DERGROUND TANK (UST) Cl_ .. UP.(LOP) Ll HOUSING ABATEMENT <br />001THERCLEANUP SITE (NOWLO ❑ FOOD FACILITY <br />DERGROUND TANK (MONITORIFIfAL) ❑ DOG KENNEL <br />[?fWARDOUS WASTE GENERATOR 9�, ❑ CHICKEN RANCH <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL <br />❑ TATTOOIBODY PIERCING <br />❑ POOL/SPA <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />to <br />r� <br />L] SOLID WASTE FACILITYNEHICLE <br />❑ WASTE TIRE U <br />❑ DAIRY (.v ) <br />❑ WASTEWATER TREATMENT PLANT 17-11 /c>�� <br />❑ PUMPER TRUCKIYARDICHEMICAL TOILETS <br />❑ LAND USE APPLICATION SITES <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REviEw: MONDAY -FRIDAY 8:00 AM•5:OOPM (EXCLUDIN© HOLIDAYS <br />1. List up to ten addressetl In the space above. Select the typo(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) 484-0138 or mail to the address Indicated gp9ve. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the END. 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 now application may be <br />submitted when the flle 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 $116 deposit prior to review. <br />5. If you need further assistance, please contact Diane Martinez, at (209) 4$8-3426. <br />N'w EHD use ONLY L. <br />EHD 48-06 <br />W/O <br />I ■ <br />�� E . L_ <br />_ <br />EHD 48-06 <br />W/O <br />