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IN <br />J1/IJ/ '2JJ'3 15:44 40886501?2 PAGE 01/01 <br />DATE RECi*(Vt;p EHD LOGNUMBER <br />C-M"V'V-EDD ENVIRONMENTAL HEALTH DEPARTMENT <br />RTMENT <br />JAN2009 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 466-3420 Fax: (209) 464-0138 Web: www.s')g <br />od <br />ENVIROMMEN i `lEALTN PUBLIC RECORDS RELEASE APPLICATION <br />PE T 0. - <br />APPLICANT: BUSINESS/AGENCY: <br />ADDRESS: City/Statii0p a i2] ��75 ��2 � <br />12- <br />PHONE (1): �� PHONE (2); FACSIMILE: =�� - 1 <br />TENTATIVE* APPOINTMENT DATE. lime: <br />(Please allow 10 business days from date of application submittal -Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $108 EE, (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 USINE$S DAYS <br />SIGNATURE OF APPLICANT ,U�'^,'') DATE <br />Electronic Information: ❑ List ❑ Map — Description: <br />Street * <br />FILE ADDRESS <br />Street Name <br />City <br />EHD USE ONLY - <br />[l Unit 1 <br />[� Unit 2 <br />1. <br />2. <br />,� `n <br />3. <br />Unit 4 <br />Unit 5 <br />9. <br />( Upit6 <br />�0 <br />Specific Date Flange of information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES r5 C <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE d <br />ER CLEANUP SITE (NON -LOP) 0 FOOD rACILITY 0 WASTe TIRE / <br />NDERGROUND TANK (MONITORINGiREMOVAI-) D(, 0 Doa KENNEL ❑ DAIRY <br />HAZARDOUS WASTE: GENERATOR ❑ CHICKEN RANGH 0 WASTEWATER TREATMENT PLANT <br />TIERED PERMITTED FACIUTI-1, 13 MOTWHoTEL ❑ Pt1MPERTRUCK/YAR0iCHEM TOILETS <br />TATioo/Bony PIERCING 13 POOLISPA 0 LAND USE APPLICATION SITES <br />L'I MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS•ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 AM-9:i1OPm Ext t t tntun Mry tnrva <br />7. List up to ten addresses in the apace 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 12 (Z02) 484-019!1 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 />8:00 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 tern (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 EHO 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 the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br />future file reviews by the game applicant may require a $105 deposit prior to review. <br />EHD USE ONLY <br />"a ©rl ? ✓>7 It S� <br />EHD48-06 &ltl4ro8 PUBLIC RECORDS 91ELFASE App FOIiIVi <br />