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Jan-06-06 08: 10A Kray' and Assoc 559 - '82190 P . 01 <br /> DATE RECEIVE[} <br /> p,r SAN 3oAcvtN COUNTYEHU LUU NUMUt (9 <br /> K <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`a Floor, Stockton.CA 95202-2708 <br /> i [►� Telephone:(209)468-3420 Fax: (209)464-0138 Web: www,9j90v.vr9/thd Zj <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIA ENcy: <br /> STATE_, <br /> AbbFtL��s: <br /> PHONE(1i l e l, �JS� i'110NE( FACSIMILE: <br /> TENTATIVE'APPOiNTmF-NT DATE: Time: <br /> (Ple"R stlow 10 buslrren days t of application Sp iHai-•rem Wvo only-mutt bo ronfinnsd) <br /> `• Cl CHECK BOX TO r.XPEDrM PFCkU£ST-:93-CO FEE(CASH OR CHECK OWLY).REQUEST PROCESSED N 3 BUSINI=S:3 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic 0 ust ❑Mop.Deacrtptian <br /> inform 8tidn <br /> FILE ADDRESS EHO USE ONLY <br /> ser"t 0 Street Nam* Ctty <br /> i r = ❑ Unit 1 S <br /> F341 <br /> Y C nit 2 a <br /> S. Unit 300 <br /> s. Unit 4 , <br /> 7. <br /> �. ❑ Unit 5 <br /> 9. <br /> to ❑ Unit 6 <br /> Specific Date Range of Infonnetion Re quested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> gGROUNpTANK[tST}CUANUP 5rrE(LOP) Q HbuBGABATfMeHT O SOLO WAE FAGfTr/VEHPCL5 <br /> R CLEANUP SME WON-LOP) l3 FOOD FACUTY Q WASTE TARE <br /> 06RGROUND TAmK(MONITOR%GMENOVAL) ❑q00 KQNWSL Q DAMY <br /> A AROMJS WASTE GENERATOR Q CiHIC AN RAkCH 0 WAIvRTEWATER UEATMENT PLANT <br /> ❑TIERSO PgMrrM FACILITY ❑MOTELIHOTEL O PL*MEX 7RUcWAADfCHZftr- L TGItETs <br /> Q TATToOII30oY PIFRCtNG ❑POOUSMA ❑LAND Use APPLOC—ATION Sn" <br /> O MUNC AL W A,ETE FACILITY 0 OTHeR(PLEASE eptc#+h <br /> WELL AND SaPYiC FEWT RECOrtDS AftE AVAUASL!WR RFVIP-W-LIQ DAY-FACAY a.I0 AM-6:6004A UD040 f40LIDAY9- <br /> 1. List up to ten addresses in the space above. Select the typos)Of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to_f2e9}a64 0138 or�mell tp the aPsco <br /> ntact <br /> .AdiCsted above. Address ranges will not be accepted--for additional assi8tance with file a dresers,co <br /> the EHO.Appllcaltions received after 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 wilfbe confirmed <br /> approximately ten(10)days after receipt of application. The tiles will be head for a en"imum of five business <br /> days for review. Appointments should be schOduiOd eccordingiy. <br /> 3. A file that is actively being worked on by EIiD staffmay not be ImmQdlatatty available for review. Anew <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$93.04 deposit priot to review. <br /> EHf3�f-0C <br /> 1rHi1l2�1 <br />