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SEP-03-2010 03 :26 PM TTINS. ENV&ENG 9492 0517 P. 01 <br /> I <br /> SAN SOA UIN COUNTYEHp LOQ NUMBER <br /> f'!I \' ; LJ� Q <br /> I� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Maln 3t, Stockton, CA 95202.3029 <br /> Telephone; (209)468.3420 Fax: (209)464-0138 Web,www,sjgov.o <br /> 0-; PUBLIC RECORDS RELEASE APPLICATION <br /> ApPLtCAWI t J Q�h G 1 r lh$ BU81NEE3/AGENCY: Glt" lkg N�• n�,��hc, <br /> ADCIF�E$ "�23 ' � PI Cly i wo <br /> CITY/STATE/ZIP; N1 i S81t)tti V; Cit 42641 <br /> PH6NE(9): PHONE(2): FACSIMILE; -1"2 - 0 r <br /> ''MUTAT/VE*APPOINTMENT DATE: Time: <br /> (Pleas*allow 10 business days!rpm date o�appllcatlon submittal. <br /> T'Tt"1110 only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 61ON TORE OF APPLICANT DATE R —3 —1 D <br /> Elaf Ofti. Anformation: []List[]Map—Description: <br /> FILA ADDF2E$$ EHD USE ONLY <br /> W <br /> �tiWRt N Street Name Clty <br /> Fe'r" <br /> Unit1 <br /> 2. �: �';� (4a $+ock1-1�honit2 <br /> 4. . 'I�qiM00 ,n?j4Wh+ H3 <br /> 6• LooM1� ���vQ l /171 <br /> 8 <br /> 8. Unit E <br /> 10. <br /> Unit e <br /> ape IfEC'b6 3 Kanas of Information Requested: From to �1 <br /> ENVIRONMENTAL' ALTH q PARTME T FILES <br /> U4 El 060 TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE i f <br /> OTHl ,N CLONUP SITE(NoN-LOP) 0 FOOD FACILITY ©WASTE TIRE 2 <br /> UNOR(tat�0NO TANK(MONITORINGIREMOVAL)I J� (SCO KENNEL <br /> i' ` ❑DAIRY <br /> HA�.�G'IIt oo <br /> 'WASTE GENERATOR CHICKEN RANCH ©WASTEWATER TREATMENT PLANT C���"�0 <br /> TII:A�b'�PdOMITT OD FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCFJYARDICHEMICAL TOILETS <br /> `lATtbd1660Y PIgRC010 ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL 1hIA'8TE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> EU #M1 . eric PtiRM1T ReCORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDINo HOLIDAYS <br /> I'• � �In the apace above. Select the type{e]of flies from the list above by checking the appropriate <br /> bq�t s), least one fila type MUST be selected. l ax tq(2Q914�4 p138 or mail to tag addreaF Indica b <br /> Address <br /> Ilifr dtz 41+111"Hot be accepted-for additional esslatance with tits addresses,Contact the EHD. Applications received after <br /> 3:0 'pm tlVlit be processed the next business day. <br /> '• TNii�!IlS40 will <br /> notify the applicant If any eHD fIlea exist. An appointment for review will be confirmed approximately ten(10) <br /> dajlrk 80 <br /> rg0 <br /> eipt of appliCatlon. The files will be held for a maximum of five business days for review. Appointments <br /> ah'bOld bb'scheduled accordingly. <br /> A#110;the j Is aretively being worked on by ENG staff may not be Immediately available for review. A new appiieption may be <br /> SU66t'itt4d When1hv file Is available, <br /> 4, ANN f to l'16tTeturnod In the same condition as released will ba reorganized by END staff at the expense of the appllcant. <br /> Ftitbre' It6 lltivlewt by the same applicant may require a$122 deposit prior to review, <br /> = �� -r �_ ♦ 7 �t 7 7 i <br />