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V41 Ivtcvva 13 rnn <br /> I�j001/001 <br /> GATE RECEIVED �) EHD LOG NUMBER <br /> �E(CE t=° ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 1 t 20oh 600 East Main Street, Stockton, 38 95202-3029 /� �j <br /> elephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov. Irl/ �o`/ <br /> ENVIRONMENTFVIEAQTN PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ' f, BUSINESSIAGENCY: Efrlerenrl <br /> ADDRESS: aq?� 1 H1�,{_(1}_l11 ��� .11-TG,[� Cityistata2lp Ea rcer <br /> PHONE(1): CRI(n) CK6-'-6 9 PHONE(2): I 0--�9`r�,' 4- FACSIMILE: �In <br /> TENTATIVE"APPOINTMENT DATE: r' t-�/ alb Time: I O A NI <br /> (Please allow 10 business days from date of application tubmittal-'Tenradve only-must be confirmed) <br /> i7 CHECK BOX TO EXPEDITE REQUEST 4705 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTiAr� t��r. 0 DATE 0 Q'��9 <br /> Electronic Information: ❑ LISt❑ Map-Desorlptlon: <br /> FILE ADDRESS EHD USSE ONLY <br /> �( Streetx Street Name City /ryG <br /> Hnk, <br /> col5f /011 <br /> 2. ZeUnft2 <br /> 3. <br /> 4. Unit 3 0 <br /> 5. <br /> B. UnK4 <br /> V <br /> 7. <br /> 6. D nit 5 <br /> 9. f^ �. <br /> 10. �nit8 <br /> Lt <br /> Specific Date Range of information Requested:From T�)CiOJ to CU-Trel-4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) �y FOOD FACILITY WASTE TIRE �/�,n„ y <br /> UNDERGROUND TANK(MONITORINWREMOVAL)V` Doc.KENNEL r=ATeWATER <br /> Y un- <br /> HAZARDOUS WASTE GENERATOR� CHICKEN RANCH TREATMENT PLANTTIERED PERMITTED FACILITY 9 MOTEL/HOYEL UMPER TRUCK/YARDICHEM TOILETS <br /> TATTOOIBom PIERCING 01 POOUSPA AND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITYDL OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:0D AM-6:00PM - 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(209)484-0138 or melt to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 8:00 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 schoduled accordingly. <br /> 3. A file that 15 actively being worked on by EHD staff may not be immediately available for review. A now application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will be reorganised by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> FNn AR.r16 Rttla1DD PUBLIC RECORDS RELEASE APP FORM <br />