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,Feb. 28. 2005L• 9:0804b40' '" WNVINUIILNIHI r d In No. 1391 P. I— C1 <br /> Yra1R n nvrY ..✓ ` .I'- CFW LULi NUMfti <br /> SA�(JoAQunv COUNTY \ <br /> lJ tT v AA 01NIVILNTAL t1fALTH MEPARTMEN1 <br /> 304 East Weber Avenue, ( Stockton, 95202-270$ <br /> ner <br /> Telepho :(209)468-3420)rax:(209)09)464-Di38 Web; <br /> www.sjgov.org/eltd <br /> BVIF OPlh4cNT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: N BU81NEWM ENCYt MIL L 06 <br /> ADDRESS: N(I , (LI MPINT' `fib � A- CA- 2 <br /> PHONE(1): gI— 'II PHONE($); `tti(—a-58.-59.71 FACSIMILE Q51-o,9f,3-{)c <br /> TENTATIVE`APPOINTMENT DATE: 03—I H—Ora 'lime:. I I'ao-I 'CSO PAA <br /> IPloolm eNw.an!.•»l... 4-. fr m da/--of oppPu Uon eebm!ttal-"7enf.i0"only-must by cunflnned) <br /> ❑ CHECK BOX TO expEDrTE REQUEST-$03.00 FM(CASH OR DHacK ONLY) REQUEST PRoCESsED IN;I BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 0_7— �/OS` <br /> UNtfblsposu'rION 0Unit 1 0Unit 1 nit4 ❑ unit s 17 Unita ❑ Other(elachonlWstalmaps) <br /> FILE ADDRESS SE ONLY <br /> sttwt0 Streat Name City <br /> MM ,45 1. 1. <br /> dIF 2. 2 <br /> N �b <br /> .�wfi(r s <br /> lim 11 <br /> S" 7. <br /> 8. <br /> 9. <br /> Specific Data Range of Information Requested:From S 4co taaLENZ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ANN&a <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATBNENT O SOLID WASTE FACILIYYNF1eOLE <br /> On <br /> OTHER CLEANUP SITE(NON-LOP) 0 A FACILITY O WASTE TRE 16 <br /> DBRORDVNO TANK(MONITORINGIREMOVAL) ❑DOG KERNEL O baRv 01 <br /> Xjtt�ARDOUS WAST[OBN4WOR 0 Cmrow RANCH ❑WASTEWATPR'(A!ATMPNY PLANT <br /> TIERED PERMITrm FACILITY 0 MOTEL7HOTEL ❑PVMPER TRUCIWAROAC14En TOLLETS11 <br /> TATTOO(BODY PMRCING O PO"PA C LAND USE APPYCATMN SITE' <br /> O MbPICAL WASTE FACILITY U OrKeR(PLPASE ePIOIPY) <br /> WELL AND SEPTIC PERM RECORDS ARE AVAR.AeLE FOR REVIEW , MONDAY-FRIDAY 8:00 AM-5:00P% - PXoLugRO HauoAYIt. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate boX(es). At least one file type MUST be Selected. Fax to(2091464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for additlonal assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be processed the next business day. �ss <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximatety ton(I 01I dave after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments snouia ue scheduled accordingiy. <br /> 3. A flee flint is ac4v miy i 6.g ..�.;, l ..,.H.hio for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any Tile not returned in the szr.:c=idMlon as released will he reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> eHo�-oz+ae <br /> t+rclaN <br />