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08/27/2007 08: 18 FAX <br /> 116 68:50. 45461y rrvvircurnncrviH_ �,n �002/002 <br /> .SAN i1 O A Q[ IN COUNTY EyD LOG NUMBER <br /> i � NVIRONMFNTAL HEALTH DEPARTMEN D <br /> 304 -ast Weber Avenue, 3rd Floor, Stockton, CA 95202- <br /> Telephoae:(209)468-3420 Fax: (209)46UI38 Web; wwv/sJ , d <br /> PUBLIC RECORDS RELEASE APPLICA. ON <br /> APPLICANT: ;;, � ;/�. <br /> [iU6lNFS3/AGENCY: lel e,>^-�<. d° <br /> ADDRESS: o < /I,( <br /> PHONE(1): _C? o_ 3`'I j <br /> PHONC(2): 7_IC?-CFO R-a6Z ( FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business days from date of a fica00 Time: <br /> PP n aubmlttal•'7enERtive onlTime: l b®conte firmadJ <br /> f7 CHECK BOX To EXPEDITE REQUEST-$9S.00 PEE(CASH OR CH9cK ONLY)-REQUEST PROCESSED IN 3 DUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: [❑ Li9f[] Map.-Description: <br /> FILE ADDRESS <br /> Stmet9 Street flame city EHD USE ONLY <br /> �- b Q unit 1 <br /> �• 2. 56 O Tnc- v <br /> 4V`5l 0�) ❑ Unit <br /> • o <br /> JLV 13c) 7-11 Dnit 3 <br /> 6, Unit4 a <br /> 7, (\ <br /> $, ❑ Unit S <br /> 9. <br /> 1 a. ❑ unti s <br /> SpeGflc Date Range of Information Requested:From to <br /> ENVIRONMHNTAL HEALTH DEPARTMENT FILES <br /> _ZI1NeeRGROUND TANK(USTj CLEANUP SPIE(LOP) 12 HOUse1G ADATrhmNT SOL10 WASn?FAChiTYNEHICLE <br /> ER CLEAN SITE(NON-LOP) ❑FOOD EAGeJTY ❑W.aaTE TRE <br /> M)RRGROUND TANK(MOMTORIN,/REMDYAL) ❑DOG KENNET, 0 DAIRY <br /> RDOUS WASTE GENERATOR 0 CMKEN RANCH WASTTrylATER TREATMENT PL4NY' <br /> ❑TIERED PERMTTTFD FACILITY ❑M0IEUHOTEL t7 PUMPER TRUCK/YARP1CHEM TOILETS <br /> C3 MEDICALTATTO0lWASTE <br /> ❑ POOUSPA ❑ LAUD UsE APPucAtteN SnEs <br /> Q MEDICAL waste FADILITY ❑OI NIP(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAIueui FOR REVIEW- MoNOAY-FgbAY0,00AM-5:00PM - ExCLUDINCIHOUDAys, <br /> 1- Ust up to ten addresses In the space above, Select the type(a)of flies from the list above by checking the appropriate <br /> boxes). At least one Fila Type MUST be selected. Fax to(209)464-0138 or mail to the address Indicated above Address <br /> ranges will not ba accepted—for additional assistanca with file addresses,contact the EHD. Applications received after <br /> 3-DO Pm will be processed the next business day. <br /> 2. The EHD will nntifytha applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of appllcatlon. The files will be held for a maximum of five businass days for review, Appeigtmenta <br /> Should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by END staff may not be immediately available for Inview, 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review., <br /> EHD USE ONLY <br /> e *4. sli ooc <br />