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0044- <br /> E <br /> -24-2(0009 11:I33am DD <br /> From- _ T-963 P.002/002 F-027 <br /> �1 U EPRONMENTAL HEALTH DEPARTOINT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> 2, 4 2009 Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www_sjg e <br /> ;? <br /> FNV'IRONMENT HEALTIJ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: APA- RAIzI cIAACDKM4 SUSINF-5VAGENCY: 9N V(leaf <br /> ADDRESS: / 001 SLF4L.M011Nj2 ST, STS -7L)O City/State/zipKIK 1/ylc-t� `� 5,4o8 <br /> PHONE(1): t5�P7420 2503 PHONE(2): FACSIMILE: 3,577 <br /> TENTATIVE'APPOINTMENT PATE: WAY (p C IP p05s1610 Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH 017 CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATIF -4 2009 <br /> Electronic Information: [I List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Name City <br /> LOCK FiF(? �/ 7D��cr a.. Unit 1 <br /> 2- Unit 2 0( <br /> 3. <br /> 4, Unit 3 <br /> 5. de <br /> 6. t tiur T le Unit <br /> 7. <br /> © Unit 5 <br /> Specific Date Range of Information Requested:From QU u 0.dI&W1 to T]� LSr v%-- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY k&VASTE TIRE <br /> UNpERGROUND TANK(MONITORING/REMOVAL) ©DOG KENNEL DAIRY <br /> HAZARDOUS WASTE LiENEF2ATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C1MOTEL/HOTEL PUMPER TRUCK/YARD/CHEM TOILETS <br /> C3TATToo/BODY PIERCING POOL/SPA ND USE APPLICATION SITES <br /> AIMEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY)�li1j,�( s2M(,- SV _M S <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(209)464-0138 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 fife 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 RECOR05 RELEASE APP FORM <br />