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.APR 26,2008 12:22 000-000-00000 t i page I <br /> `— G NUMBER i <br /> SAN Jt�AQUIN CQUNTY� EHD LO <br /> APH 1 6 IUCD <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIi i 0 '-0,EJ;`J i iii=�LTH Telephone: (209)466-3420 Fax: (209)464.0138 Web:WWw.sjgov.o le h .5k <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT': r T BUSINESS/AGENCY: <br /> ADDRESS; _ <br /> PHONE(1):A ffa r j11_'_6+�3 <br /> PHONE(2): ~7' <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE; <br /> (Plesse allow tan business days from data of plica on submitfsf-'TCnfative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUES - t (CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE 13USIN SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: Ej List D Map-Description: <br /> FILE ADDRESS <br /> st„�etlf _ EHD USE ONLY <br /> $!feet Name Char <br /> rJ Unit i <br /> z. c�. p <br /> a. N sant{{,,.---- <br /> 6. <br /> 7. ,~ <br /> jr <br /> B. <br /> I0. Ii" Edt'5no -1L, nit <br /> Speciftc Date Range of Information Requested:From <br /> ENVIRONMENTAL HF-ALT14 DEPARTMENT FILES <br /> ���rrr i <br /> UNDERGROUND TANK(UST)CLEANUP SITE LOP G LID WASTE FACILITYNEHICLE <br /> (LOP) HOUSING FACILITY <br /> lISNr <br /> OTRFdi CLEANUP SITE(NDN LOP) ❑FOOD FACR r1Y ASTE TIRE I <br /> .IKUNDERGROUNDTANK IIMONITORII WREMOVAL} Q DOG KENNEL 13 DAIRY <br /> AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ©WASTEWATER TREATMENT PLANT 1 <br /> TIERED PERMITTED FACILITY 0 MOTEL114oTEL C3 PUMPER TRUCKlYARDICHEM TOILETS <br /> 0 TAMOIBODY PIERCING 0 POOLISRA 0 LAND USE APPLICATION SITES I <br /> ©MEDICAL WASTE FACILITY 0 OTHER(PLEASE 3PECifYI ` <br /> WELL,AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM.6:00pM_EXCLUDING HOLIDAYS- <br /> 1. List up to ten addresses in the space above. Select the type(q)of flies from the list Above by checking the appropriate <br /> box(es). At least ons file type MUST be selected, Lax to(2091464-0138 mail to4h'10vf�ldrs . Address ranges will <br /> not be accepted-for additional assistance Wlth file addresee4,contact the EHD. Applications received atter 3:00 pm Wail <br /> be processed the next business day. <br /> 2. The EHD will notify the appilCant If any EHD files exist. An appointment for review will be confirmed approxhn <br /> days after receipt of application. The files Will be held for a maximum of flve business days for review. Appolately ten <br /> ntfnenW <br /> should be scheduled acCordingiy. <br /> 3. A file that is actively being worked on by the EHD staff may not be Immediately available for review. A new application <br /> may be submitted When the file Is available. <br /> 4. Any file not returned in the soma condition as released Will be reorganlzed by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$96.00 deposit prlo�to review. <br /> EHD USE ONLY <br /> eND4s�oa ia�arrc, --- _ . <br /> 'PUBLIC REdORDE Ri ASE APP OFRM <br />