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04-14-2008 11:13am Fram- T-063 P.002/002 F-027 <br /> REECOVEDD ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA,95202-3029 <br /> > /// <br /> rd 2 4 2009 Telephone: (209)468-3420 Fax: (209)464-0138 Web: wwW.sjgdrL�'�le2 <br /> ENVINUNMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION(((((( <br /> APPLICANT: A_4rl RAI-IC, AO'DKAr! BUSINESS/AGENCY: 6NVff'_ON <br /> ADDRESS: 61 2FL&LA14I/ND ST'TE It' City/state/Lp vl C/4 D <br /> PHONE(1): &63420 '2-50 PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: MhV (o IFPOS61{ajtC� _ Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT $kauDUL -t;Gj�+ pDATE 412-412009 <br /> Electronic Information: []List❑ Map-Description: (� <br /> FILE ADDRESS END USE ONLY " <br /> Street# Street Name city nit <br /> 1• 12 O t E $RA \, <br /> 2 \J <br /> 3. ,Ja` <br /> Unit 3 <br /> 4. <br /> Unit 4 <br /> s. <br /> T' ❑ Unit 5 <br /> . 8. <br /> E190, <br /> Unit 6 <br /> Specific Data Range of information Requested:From AJ l G1..lW& to P VGS WA4C <br /> ENVIRONMENTAL HEALTH DEPARTMENT�FILES ID <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT SOLID WASTE FACILrTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITYWASTE TIRE <br /> UNDERGROUND TANK(MONrrORINWREMOVALE>` 0 DOG KENNEL DAIRY \f✓ <br /> HAZARDOUS WASTE GENERATOR p.% CI CHICKEN RANCH WASTEWATER TREATMENT PLANT ,1 <br /> TIERED PERMITTED FACILITY d.. 13MOTEUHOTEL PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING NOrPOCUSPA D USE APPLICATION SITES <br /> MEDICAL WASTE FACILnYa r OTHER(PLEASE SPECIFY) WC'LLG11 SM G SV STF_MS <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW - MONDAY-FRIDAY 8:00 AM-5'00PM - E%CLUDaLG 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 type MUST be selected. Fax to(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END 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 File that is actively being worked on by END 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 END staff at the expense of the applicant. <br /> Future rile reviews by the same applicant may require a$105 deposit prior to review. <br /> END USE ONLY <br /> f(p. <br /> fJ ZS �S <br /> EHO 48-06 5104100 PUBLIC RECORDS RELEASE APP FORM <br />