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j - - - - ` - [woof — ' - - - - - - - ... , .. .. nwA1 � l.VU1Vr;;' .,� �.�� , i tnu LOGNUVi <br /> MBER <br /> 1 1 tONMENTAL HEAL <br /> 304 East weber Avenue, ro Stockton, <br /> kaon,J)EpCA/ Telephottc: (209) 468-3420 Fax 09�64 tOOkton, CA 95202-2708 /�/� <br /> F - ( ) 0138 Web: WWW*sjgcv.org/ehd �/ <br /> PUBLIC RECORRS RELEASE APPLICATION <br /> APPLICANT: <br /> ADDRESS: I LONE <br /> PHONE ij 9pgLM V6 � BUSINESSIAGENCY: <br /> t •Slq • 2Z2( SSO <br /> PHONE CITY E STATE` <br /> TENTATIVE• APPOINTMENT DATE: (Z1n: <br /> �NI o lo FACSIMILE: 2 oq . 5 q • 2u!-. <br /> (Please snow to busilwss day* from date of application suiImldal . 9rentaUve only • must be oonnnned) <br /> CHECK BOX TOEXPLOIT EREQUEST - Time: A : _ <br /> SIGNATURE OF APPLICANT f9s.ep FEB (CASH OR CHECK ONLY) . REQUEST PROCESSED IN 3 BB=USINESS DAYS <br /> leclroDlc <br /> mlaUDR List o Map - Description C -�--_. DATE •_`� `1 9L, <br /> Iero <br /> stneat r FILE ADDRESS <br /> street Name Gay <br /> CHD USE ONLY <br /> 4. ❑ Unit 1 <br /> 5. Z ❑ Unit 2 <br /> 8. Unit 3 <br /> 10' Dom ' oplou <br /> a Unit 5 <br /> IBMr <br /> SRecific Data Range of Information Requested: From p Unit 6 <br /> ENVIRONMCNTAL HEALTH DEPAR�Tq�ENT FILL <br /> IkUNDERGROUND TANK (UST) CLEAHUISnE (LOP) d <br /> Q OTHER CLEANUP tiITFfNONA.OP-) -... . -. HOUFNIG AeArEMFNT -. . - . <br /> Q UHDERGROIIND TANK MONITOR" Q FOOD FACAITr C7 sDLR+7tIASTE FACILRYlYFFiICIE - <br /> ( GIREMOVAL) Q DOG KENNEL G $WAIoUo AS <br /> ltALAR000S WASTE GENERATOR tJ <br /> Q TIFAED PERMITTED FACILITY Q DAIRY <br /> CHICKEN RANCH dAIRY <br /> O TATTOWBODY PIERCING WASTEWATER TREATMENT PLANT <br /> Q MOTEUROTEL TRUCK/YARp(CHEMICA <br /> U PUMPER L TDILETS <br /> Q MEDICAL WASTE FACILITY O POOUSPA <br /> WELL AND SEPTIOPERAETRECOROS ARE AVAnVisa III,,AELE TKIIII 111 ,,, 11R (PLEASE sPECP17 Q LAND USE APPLICATKN.I SITES <br /> OR <br /> . ` t.. List Op f0 ten addresses ln .ihe space above. Select the MCNDAYFRroAY r:W AM-e;eDPM - EXCLUDING HOLIDAY*, <br /> appropriate licx(es). At least one file type(s) of files from the Ilst above by checking the <br /> ndioated lt�ova Address type MUST be selected. Fax to12091464.0136 or man to the address <br /> ranges will not be accepted fDr additional assistance with fife addresses, contact <br /> the EHD, Applications received after 3:00 pm wpi be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files axis(,xist. An <br /> approximately ten {10) days after receipt of !i Appointment for review will be confirmed <br /> days for review. Appointments Shouldapp cation. The files will be held for a m <br /> be s maximum o <br /> 3. A file that is actively halo w scheduled accordingly, f five business <br /> 6 worked t of leis stall may not be immediately available for review, A new <br /> application may be submitted when the Rig 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 /> FXDUAI <br /> 1N51/laOA <br />