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May 15 08 12'.25p Paul Humphre (5.59) 226-3408 P.1 <br /> v <br /> EHD LOG NUMBER <br /> M DD SAN TAL HEALTH <br /> COUNTY �, <br /> ENVIRONMENTAL HEALTH DEPARTMENT Q����"""' ?-70 <br /> MAY 1 5 2008 600 East Main Street, Stockton, CA 95202-3929 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web.WWW.Sjg v.o <br /> ENVIRONMENT HEALTH <br /> PFRMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAGENCY: <br /> APPLICANT: L� w _ '� <br /> ADDRESS: ^/`IOL ` I d v� FACSIMILE `25-j 20L- <br /> PHONE <br /> ='/, �YGk <br /> PHONE(1): L y77� /� PHONE(2): <br /> Time' <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow ten business days from tlate of application suhmitfal•"Tentadve only•must be confirmed)BUSINESS DA <br /> HECK BOX TO EXPEDITE REQUEST•$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSEDDATE IN THREE B <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑ List❑ Map-Description: <br /> EHE ONLY <br /> FILE ADDRESS D US <br /> Street# Street Name <br /> City D Unit'I <br /> `- t. %vim r, Altl I . <br /> 3 J Z � D µbU/08hivo5F-6 o.coMp• -itz G1 <br /> i. � �siv �, I rte» ,]�,,✓! Dom, yl <br /> 3. 2735 e Z IT <br /> a -r — <br /> s. Pile � G i <br /> �nN4 <br /> ,dk 6. <br /> 7. ❑Unit s <br /> 8. <br /> g• e' nit 6 <br /> 10. <br /> to <br /> Specific Data Range of Information Requested:From \� <br /> ENVIRONMENTAL PA TME S <br /> E3 HOUSING ATEMENT LID WAGTE FACIUTYIVEHICLE C\Q <br /> t5:UNDERGROUND TANK(US�CLEANUP SITE(LOP) ❑FOOD FACT LITY WASTE TRE <br /> � <br /> THERCLEANUP SITE DAIRY <br /> I�.IINDERGROUND TANK(MONITORWGIRENN]VAL) ❑ OO KERNEL13CHICKEN RANCH -K WASTEWATER TREATMENT PLANT <br /> -HAZARDOUS WASTE GENERATOR 0 MOTELIHOTFL In PUMPER TRUCKIYARDICHEM TOLETs <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOWBODY PIERCING 0 OTHER(PLEASE SPECIFY) <br /> 0 MEDICAL WASTE FACILRY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW• MONDAY.FRIDAY 8:00 AM-S:00PN • EXCLUDING 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 above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applicallons received after 3:00 pm will <br /> be processed the next business day. <br /> 2. The EHD will notify the applicant if any END files exist. An appointment for review will be confirmed approximately ten <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 the EHD staff may not be immediately available for review. A new application <br /> may be 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 file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> i� 3t,33 Grufc <br /> I <br /> PUaLIc RECOft05 RELEASE APP FORM <br /> EHD 46-06 10/2916] <br />