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DAYS RECEIVED EHD LOG NUMBER <br /> SAN .l10AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3ra Floor, Stockton, CA 95202-2708l _ <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd 70 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: KPr BUSINESSIAGE14CY: ETICfPlef-1 71} <br /> ADDRESS: ,;JR5 Move& t rafant 'c - L <br /> PHONE(1): e25- (0011 -4FIQ X41 PHONE(2): 9->5-o!r!J -.S�.36 HCl(/) FACSIMILE: 51;-75-x+01 -51'51,2d <br /> TENTATIVE`APPOINTMENT DATE:__ b'w6Laf.'34,7na f Time: /0*tj <br /> (Please allow 10 hualness days from ate of ap ieatiOn submittal.`Tentaave only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST�-/$95.00 FEE(CASH OR CH,9CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT rv(�GLti2 r d> �Gt e4f�j DATE Q Z/ <br /> Electronic Information: L] List❑ Map—Description, <br /> FILE ADDRESS EHD USE ONLY <br /> Street If Street Name Ciry ❑ Unit 1 <br /> 1. SOS W CHartUr W ,r L <br /> 2. 37 5 W C114r a W flvC�,aY� :{�y 4 ❑ Unit 2 <br /> 3. <br /> VV (,h4014- JHL <br /> 4. 411 N/ C at-& m C�.tavt� x t <br /> Unit s <br /> 5. X )tj W 0Add k1r WAG <br /> B. 140 S � r unitd <br /> a fkJ ' <br /> 7. <br /> 8. ❑ Unit <br /> 9. <br /> 10. Unit 8 <br /> Specific Date Range of Infomhation Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP$ITE(LOP) d HousiNG ABATEMENT J3—GLID WASTE FACILITYrVEHICLE <br /> OTHER CLEANUP Sim(NON+LOP) DFOOD FACILITY MWASTE TIRE <br /> d UNDERGROUND TANK(MONRORINGIRENoVAL) 0 DOG KENNEL ❑DAIRY <br /> ,id HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ;,CfTIERED PERMITTED FACILITY OMOTEUHOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOIBODY PIERCING ❑POOLISPA ❑LAND U$EAPPLICATIONSITES <br /> 0 MEDICAL WASTE FACILITY D OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AMS:ooPM - EXCLUDING HOLIDAYS. <br /> 1. Llst up to ten addressor In the space above. Select the type(3)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 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 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 scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be 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 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 /> EH048oa Sh3=06 <br /> TO 3E)Vd Hd 9NI2133NION3 0113 OZLbZ09GZ6T ZO:60 9002/ZT/ET <br />