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Sep 01 05 06: 23p Pa Humphrey _ (559 226-3408 P. <br /> EHG LOG NUMBER <br /> R�°�'EE�tF�l`i�D SEN TAL HE v COUNTY 40226g, <br /> � �," u�/1� ENVIItONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton,CA 95202-2708 <br /> MAR 1 [006 Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ebd <br /> ENVIRONMENI HEALTH pUBLIC RECORDS RELEASE APPLICATION <br /> PE BUSINESS/AGENCY: <br /> ADDRfss E A rc ! r » <br /> PHONE(-q: 55`f-1177 -IRQ 13- PHONECn: FACSIWULE: <br /> TENTATIVE'APPOpRMENT DATE: - Tom' <br /> . (Pleas,Nte lw is buslD days from daDE eppticetlal subrn*W- 11-(O"odY-must be comnnal) <br /> CHECK BOX TO ExPEDRE REDU $93.00 FEE ASH OR HECK ONLY)-REQUEST PROCESSED in 3 BUSINEV,DAYS <br /> SIGNATURE OF APPLICANT - <br /> DATE <br /> UWR OIS7'WBUTION OUdt1 ❑Udt2 OUnK3 OUn 4 OUnit5 O Units O OUler(ekKb0MclBMah naps) <br /> FILE ADDRESS i;3-SLj EHD USE O <br /> Strost! 8uast Noma CRY a 9 <br /> 2. <br /> 3. <br /> 4. w ri <br /> 5. — <br /> 8. <br /> 7.. <br /> 8. <br /> 9. <br /> specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES -� ��© <br /> AS UNDERGR n TANK(UST)CL UA SHE(LOP) 0 Hou AaAvwM �SQUD WAaTE FAmJrYNE+BGLE <br /> n <br /> O Om CLEANUP SHE(Nowt-op) O FooD FAauiY XE WA '_ ,I/1 J p <br /> $'UNDERGROUND TANK p40WrORWG,`REMMV ) ODoo KFRex:L ❑ AI <br /> DRY PGRHi 2 2000 <br /> HA O,Que WASTEGENERATOR 11 CHANC <br /> ICKEN RH O WASTEWATER TaEArAfNT <br /> ❑TERED PEW;==FACIM O MOTE MOTEL 0 pMN TRucN/YARDICHM TDILkTs <br /> O TATTOD/600Y PIERCMG O POaJSPA• 9 eE APPLicATKiN SrtEs <br /> MED WASTE FAGILRY ;MOE M(PL ESPeam <br /> WELL AND SEPTIC PERM REO m AeE AVAILABLE FOR REVIEW- Mol y-FR10AY 0:00 AM-6:e0PM - EXGU Mil HOUOOY'!L _ <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)4640138 or m-A to the p(ktress <br /> indicated above. Address ranges will not be accepted—for additional assistance with fife addressts,contact <br /> the EHD.Applications received after 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 confirmecl <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHO staff may not be immediately available for review. A new <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$93.00 deposit prior'to review. <br /> BID 4M4N <br /> +n.Gs <br />