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DATE RECEIVED EHD LOG NUMBER <br /> SAN,TOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd23131 <br /> ^ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: RTF-NdR -DF IC(/-�= BUSINESS/AGENCY: AAVQYI�-& ae0 41V fonWk-N <br /> GA <br /> ADDRESS: 37 ShaUJ ROCAA ,�C)L-'4"_0 <br /> ^0 <br /> PHONE(i): q-110-M� PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> yot CHECK BOX TO EXPEDITE RE EST 3.00 FEE ASH O K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� DATE " ')-aOD6 <br /> UNIT DISTRIBUTION ❑ Unit 1 ❑ Unit 2 ❑ Unit 3 ❑ Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. IINS 0%y r W S}mC Y, <br /> 2. <br /> 3. <br /> 4. 14 4% <br /> 6. <br /> 5. <br /> 7. <br /> 8. <br /> 10. 1 1 <br /> Specific Date Range of Information Requested: From to DYE <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY1VEHICLE <br /> 17 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 7 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM - 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses, 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 confirmed <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 EHD 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 /> r <br /> EHD 46-02-006 <br /> 1114105 <br />