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10102/2008 30: 17 FAX X 001/001 <br /> OA"; k0 -�I4J I `I .SAN .10AC�U1N COUNTY HHD LOG NUMBER <br /> a kms � jL_,I- <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 2 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone; (209) 468-3420 Fax: (209) 464-0138 Web: www,sjg(iv.org/ehd <br /> F[ `JlCiai} Nil- WcALTH <br /> P RNfi!T`SFRV1CI~3 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: V cftylsttatWzfp it' o <br /> PHONE(1): PHONE(2)- �L�R !6n 0 13B6-q FACSIMILE: <br /> TENTATIVE"APPOINTMENT DAT4 Time: <br /> (Please allow 10 business day fro date of appf tion submittal-"Tenfativo only-must b conflrmod] <br /> 0 CHECK BOX TO EXPEDITE R QU - 06 FEEGAS R ONLY)-REQUEST PROCESSED IN$BU31N S DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: Q List ENap—Descrlpt on; <br /> FILE ADDRESS EHb USE ONLY <br /> Street# ;;treat Name CLty <br /> 1. me- Q 5 p Iii a <br /> 2. �', I+L VL)CO(W + ifUr 2 <br /> 3. <br /> PJ f <br /> 5. <br /> unit; <br /> 7. f o 2'Al <br /> �f Unit S <br /> .I I that% y, an C f '��i f� f�±^I� p�i , NO f_.0 Unit 6 <br /> 10. C] � c 'o tj <br /> Specific Date Range of Information Requested: From CY to a<' <br /> tir ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> VL1 JAZARDOUS <br /> DERGRROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT LID WASTE FACILITYIVEHICLE /: vi` ' <br /> HER CLEANUP SITE(Nom-LOP) Q'FOOD FACILITY Tic TIRP t�[/ Fhh^^^ <br /> DERGROUN@ TANK(MONITORINWREMOVAL)y ❑ DOG KE.NLL AIRT 1�f/�"I <br /> np _ WASTE GENERATORD4C d CHICKEN RANCH sTEWATER TREATMENT PLANT <br /> ❑TIERED PLRMrrrED FACILITY 11 MOTELIHOTEL mPFR TRUCKIYARDICNEM TOILETS <br /> ❑TATTOOIBUDY PIERCING ❑POOLISPA NO USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASESprcIFY)__ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW . MONDAY-FRIDAY 8:00 Ani-6:00PM -ExCLuDrNa 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 typo MUST be selected_ Fax to(209)464-0138 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 attar <br /> 3:00 pm will be processed the next buslneas day. <br /> 2. The EHD will notify the applicant if any EHD files exlat. 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 ilio 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 thn 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> 10-1 c <br /> EHD 48-06 8!04109 PUALIC RECORDS RELEASE APP FORM <br />