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044--24-2009f�11:12am �F'rom- j_ _ T-963 P.002/002 F-027 <br /> �-&+ RONMENTAL HEALTH DEPART � <br /> ��NT <br /> 600 East Main Street, Stockton, CA 9520223029 <br /> At'R 2 4 2009 Telephone: (209)468-3420 flax: (209)464-0138 Web: irvww_sjg e <br /> El�YIt"TUTpIYIEIVT HEA.T� 22?0 <br /> i <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> `{ <br />+ APPLICAN�SPA Ir F_( D 1V 8U$IrN1=5$1AGENCY: _ENLI O� A/ <br /> ;i <br /> ADDRESS: b Sit ST STE aD Ciitylstatkizlp INQeYVILL6 CA O <br /> PHONE(1): LSrv��k20 �2S03 PRONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT PATE: kkA DS51431 Time: <br /> (Please allow 10 business days from date of application supm)ttal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST.$105 FFE(CASH OR CHECK ONLY)�-'REQUEST PROCESSED:IN 3 BUSINESS DAY$ <br /> SIGNATURE OF APPLICANT DATE -2-42DO <br /> 'r <br /> Electronic Information: 0 List❑ Map-Description: �( <br /> FILE ADDRESS iE EHD USE ONLY <br /> Street# Street Name City unit1 <br /> l 1 o Z F LOCK�F�1 <br /> F. Unit 2 <br /> 3. <br /> 4- �' - •t 3 <br /> 5. <br />€ Unit 4 <br /> 7. <br /> Unit 5 <br /> Unit 6 <br /> 10. <br /> Specific )ate Range of Information Requested:From GW Lt, �ri4rOleJ _ _ to ,Sg&N-I' „ <br /> r� <br /> ENVIRONMENTAL.HEALTH DEPARTMENT PILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT X. rSOLID WASTE FACILITYNEHICLE <br /> f OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MoNITORINGlREMOVAL) l3 DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CwcKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACR-IY M MoTEUHOTEL PUMPER TRUCKIYARD/CHEM TOILETS <br /> fl TATTaa/Boor PIERCING ElPoaLISPA °i ND U3r APPLICATION SITES <br /> P MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> E WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR ReviEw- MONDAY-FRIDAY 8:00 4M-5:00PM - 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 /> E box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address indicated above_ Address <br /> ranges will not be accepted–for additional assistance with file addresses,corriact the EHD. Applications received after <br /> 3:00 pm will be processed the next lousiness day_ <br /> 2. The EHD will notify the applicant if any END tiles exist. An appointment for review;will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held fora 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 be immediately available for review. A new application may be <br /> submitted when the file is available. l <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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8104/06 PUBLIC RECORDS RELEASE APP FORM <br /> 1 <br />