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LLVf $ $IVED EHD LOG 14VM15ER <br /> SAN.�OA.QUJN COUNTY <br /> jl-Iik_ Z 0 2007 ENVIRONMENTAL HEALTH DEFARTMENT .J 1� <br /> 600 E.Main Street, Stockton,CA 95202-3029 <br /> c-i 1`t i 1)-1 `Ss'':.l_N( EN�idepbane:(209)468-3420 ram(209)464-0138 Web:www.sjgoy.o <br /> /PLJPLjCjREC0RDS RELEASE APPLICATION <br /> APPLICANT: _ USINESSIAGENCY: <br /> ADOR 64 <br /> PHONE(11' FACSIMILF;: O <br /> TENTATNE'APPOINTMENT DATE: Time; <br /> (Please e11ow 10 business deya from date of Application Submittal-"TeMef/ve only•moat be cbnfYrmed) <br /> ❑ CHECK ROx TO F_XPFOAP RFMIP $Qkon FFA(CASH HEp ONLY)-RCOUCST P1ToC1S88EP IN*O NC*o DAY* <br /> SIGNATURE OF APPLICANT DATE 9 C7 <br /> Electronlclnformation: ❑List❑ Map—Dagcription: <br /> FILE ADDRESS _ EHD USE ONLY <br /> straeta street Namo city .._._ ... <br /> (�� �� 6� ❑ unlit <br /> Unit 3 <br /> s. <br /> y. — ❑ Units <br /> 9. LcY � , — Unit6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIL,rwS <br /> UNDERGROUND TANK(US))CLEANUP SITE(LOP) Cl HOUSING AsATEMEHT SOLD WASTE FACIUTTIVEMICLE <br /> THER CLEANUP SITE(NON-LOP) 0FOOD FACILITY WASTE Tint <br /> WERGROUND TANK(MONITORINWREMOYAL) ODoe KENNEL ❑DAIRY <br /> AZARDOUS WASTE nENRRATOR 0 CHICKEN RANOH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILTTY ❑MOTEWHOTEL ❑PUMPERTRUCKIYARDICHEMTOILETs <br /> ATTOOISODY PIERCING O POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEWCALWASTE FACILITY O OTHER(PLEASE SPECIFY),_ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AOAILAeLE FOR RfwFw- MONDAY-FRIDAY 5:00 AM-5:00PM - ECCLUDiW HOLIOAYs. <br /> 1. List up to ten addresses in the space above. Select the typo(s)of flies from the list above by checking the appropriate <br /> box(s9)- At IssAt ails file type MUST he aalsr-tad.'Fax 1n(?OA)AU-AJAR Ar rAeil to the addrecs1Ddlc4lad*bow. Adtimns <br /> ranges will not be accepted—for additional assistance with file addresses,Contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHO 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 flit 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 retumed.ln the same condition as released will he reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the some applicant may require a 49x.00 deposit prior to review. <br /> EHD USE ONLY <br /> cNn u. Anaram sra <br />