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k:+xu'.yxxu¢rv.'.;r4pMct,± , 'lir <br /> L-M <br /> e(11•T1�A,jz-}'l+p <br /> ENYrr<t))VN ENTAL LiEALTfI DEPARTNTew <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> 2005 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.ordchd <br /> VIR9N�1EN5 HEA�TN PUBLIC RECORDS RELEASE APPLICATION <br /> v \ <br /> APPI.I ANT:,Ay, AWV��QnBUSINESSIAGENCY: <br /> ADDRESS: �_• U M \J <br /> PHONE(1):?O` - (ry�" C,9 V) PHONE(2): FACSIMILE: <br /> LUZZ— <br /> TENTATIVE'APPOINTME14T DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> �\ ❑ CHECK BOX TO EXPEDITE QUES $93.00 FEE(CASI8 OR CHECK ONLY)–REQUEST PROCESSED IN J YUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3-(bc <br /> UNIT DISTRIBUTION ❑Unit 1 ❑ Unit Unit Unit 4 -❑ Unit 6 ❑ Unit 6 ❑ Other(electronicllists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 1 Street Name City <br /> AST1. Wa t d3ai 381 � 9z4 23ri <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> G. - <br /> 7. <br /> 8. <br /> 9 '10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> GROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SouD WASTE FACIJTYNEHICLE <br /> gTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> 6Y UNDERGROUND TANK(MONRORINGIREMOVAL) ❑DOG KENNEL 13 DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FAcKm ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTo07BoDY PIERciNo ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyiEw- MONDAY.FRIDAY 6:00 AMS:oOPM - EXCLUDING HOUGAYS.- <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(209)4G4-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contac <br /> the EHD.Applications received after 3:00 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be 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 <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD U-02-006 <br /> Tlnvoa <br />