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EHD LOG NUMBER <br /> vrscel <br /> SAN .10AQUIN l�UNTY <br /> 211 ENVIRONMENTAL HEALTH DEPARTMENT <br /> N 4 600 East Main St. Stockton CA 95202-3029 50qq <br /> Hone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> aoNM�isERv�GES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: e N ltH BUSINESS/AGENCY:_ ne,ra,v. <br /> ADDRESS: 3 34S YYID.yecu2 St. C CITYISTATE/ZIP: ,ern t �� <br /> PHONE(1): - t5-x3b PHONE(2): FACSIMILE; 61k� y$o-060-5 <br /> TENrA 1VE-APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST A122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A � V, DATE ?v <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Stmt# Street Name City E1JJtnIt 1 <br /> 1. <br /> 2. S. Zr�r nit 2 <br /> 3• ss o3 S. Jac V1-1�Y.y{�� \1 <br /> 4. Zc Gi aU� Y.ee_(C,-"J <br /> nit 8 <br /> 5, <br /> Unit 4 -1 <br /> 7. — 1 <br /> B. <br /> 0 Unit S <br /> .?t" �b it Hite fJ <br /> Specific Dato Range of Information Requested: From Hoo to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES � <br /> Q�NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ u,HOUSING ABATEMENT ID WASTE FACILr YIVEHICLE/ (< WAd/ <br /> 3tER CLEANUP SITE(NON-LOP) El Fool)FACILITY STE TIRE <br /> ERGROUNDTANK(MONITORINGIREMOVAL) ❑DOG KENNELRJURY <br /> ARDOUS WASTE GENERATOR [:1CHICKEN RANCH STEWATER TREATMENT PLANT <br /> TIERED PERMrrrED FACILITY El WTEUHOTEL LIMPER TRUCKIYARDICHEMICAL TOILETS <br /> El TATTOOIBODY PIERCING 2PooLISPA LAND USE APPLICATION SITES <br /> 'EDICAL WASTE FACILITY El 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 appropriate <br /> box(es). At least one file type MUST be selected. Fax to(20914!340138 or mail to the address Indicated aboyL. 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 tan(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 now 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$122 deposit prior to review. <br /> END USE ONLY <br /> END 4646 <br /> 0lr26/10 <br /> 100/L008 XVJ 8E 01 ILOVVL/90 <br />