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EO'd _d101 0 0 <br /> DATE RECEIVED( �/j END LOG NUMBER <br /> MOVED ED ENVIRO MENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> APR 2 j 2009elephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjgov,org d o <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION6. ,^ <br /> APPLICANT: 1 <br /> _ BUSINESS/AGIEEN`NIC�Y: <br /> ADDRESS: S /J. W tec, ^w. / e- A City/Stata2ip <br /> PHONE(1): 401 Rq '470PHONE(2): ZxA JZI-I FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time:�,t <br /> 7V-r <br /> (Please allow 10 business days from dpro .'Tentative <br /> c3•����7�J+��b/ <br /> submittal.•Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-5105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 4/4 Zf— 09 <br /> Electronic Information: ❑List❑Map—Description: <br /> ADDRESS END USE ONLY <br /> Street fe Street <br /> 41.. <br /> ago <br /> ..,.N8ame City_ <br /> _ <br /> o1 <br /> z. 6OLSNa co"? <br /> 3 <br /> {+�Fle ❑ <br /> wa _, <br /> ��aMUnit <br /> t3 <br /> b <br /> k6. <br /> . 10 Ynpt�.._f .y_ µ 5 ,APPllana IO( I <br /> 8. <br /> $ ❑ Unft6 <br /> ...... ❑ Units <br /> 10. <br /> Specific Date Range of Information Requested:From eor-11ce to /I7a) <br /> ���,,,,,,,,,,,,,,,,,,////// ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HDD5ING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> tenTHER CLEANUP SITE(NON-LOP) 0 ❑ <br /> ) FOOD FACILITY WASTE TIRE 'U <br /> z�I.y7qU'NOERGROUND TANK(MONITORINGIREMOVAL)DC 0 DOG KENNEL 0 DAIRY <br /> '4nAZARDOUS WASTE GENERATOR^x 0 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY t7 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING ❑POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 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)464.0138 Or mail 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 /> 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 he 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 file reviews by the same applicant may require a$105 deposit prior to review. <br /> END USE ONLY <br /> 0 — <br /> uJ 119 <br /> -0 'v o X3 <br /> d• 3p3 <br /> END 48-06 0100/08 - PUBLIC RECORDS RELEASE APP FORM <br /> 2020'd 6650 998 S26 T Q31UNOdb00NI 030N3 ££:9T 6002-T2-Jdti <br />