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II 9-14-08; 9:46AM; ;2099836960 # 2/ 2 <br /> DATE RECEIVED EHD LOG NUMBER__._.._ <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> j PUBLIC RECORDS RELEASE APPLICATION <br /> I <br /> I <br /> APPLICANT: Toon <br /> jBUSINESS/AGENCY: 022 TiU Lf _ <br /> I ADDRESS: UL U41 {'1pyvIP1 b� -jy f' /OJT� ,��c�, qq City/State/Zip ✓I�e'k' OAJ 619 'pp),i UC <br /> PHONE(1): Zc� 2 Vy - jS m _ PHONE(2): 4`�1__ fos'y0 __FACSIMILE: 205 20T —A96G <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 0 CHECK BOX TO EXPEDITE REQUEST- 05 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BYSIN/ESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street <br /> # Street Name City <br /> 1• �O /77 d u/u /4c LA.jr piNa Unit 1 <br /> 5 <br /> 2. ❑ Unit 2 <br /> 3. <br /> _ 4. APSR3 <br /> 5. <br /> 6, Unit 4 <br /> 7. <br /> a ❑ Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested:From to r7 <br /> yyy ENVIRONMENTAL HEALTH DEPARTMENT FILES rte. <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 13SOLID WASTE FACILTTYIVEHICLE 11 <br /> ���rrr OTHER CLEANUP SITE(NON-LOP) <br /> 13 FOOD FACILITY 17 WASTE TIRE p <br /> y�UNDERGROUND TANK(MONITORINGIREMOVAL)� ❑DOG KENNEL ODAIRY g11-41a <br /> HAZARDOUS WASTE GENERATOR OL 0CHICKEN RANCH -' 13 WASTEWATER TREATMENT PLANT <br /> ITIERED PERMITTED FACILI YO( ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEM TOILETS <br /> CT TATTOOBODY PIERCING O POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAYIFRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the types)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 Tile 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 EHD 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 EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any rile not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future fila reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> A hes, arP AM s <br /> EHD 49-OB 8/04108 PUBLIC RECORDS RELEASE APP FORM <br />