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• I <br /> ynEHD LOU NUMBER <br /> I � �� `� L� ��' SAN <br /> ENVIRONMENTAL HEALTH DEPARTM>'NT <br /> O (; 1. 2007 600 East Main Street, Stockton, CA 95202-2708 J.00 <br /> E(Il;/i ; (;il`ii1;1%hJi H 'FLTeleghone: (209) wNV-W.sjgov.org/ehd <br /> Fax: (209) 464-0138 Web : w .sjgov.org/ehd <br /> i . . <br /> PUBLIC RE, CORDS RELEASE APPLICATION <br /> APPLICANT: S U K H .7 / f S • V •q S W e4 L_ BUSINESS/AGENCY: <br /> ADDRESS : <D /`VK ..0 pe , - 7c CfC 7z� Aj C - <br /> PHONE (1 ): �ea d7 30. 7 — J 1 T7 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 /> CHECK BOX TO EXPEDITE REQUESBpT�J- $98.00 FEE (CASH OR CHECK LY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ StuJ/d�iT S �� > � u^ 1 DATE / C O <br /> Electronic Information : ❑ List ❑ Map — Description : <br /> FILE ADDRESS EHD USE ONLY <br /> Street # Street Name City ❑ Unit 1 <br /> 1 . <br /> 0 / E. CL I c 'CAI) Q S 70 GiCox a <br /> 2, lc ti JSa lC ❑ Unit 2 <br /> 3 . Ili rrr <br /> nit 3 <br /> 4 U <br /> 5, Unit 1Q <br /> 6. Vpy <br /> T __-- ❑ Unit , <br /> 8 . <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ,y� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 11 SOLID WASTE FACILITY/VEHICLE <br /> 9 OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY El WASTE TIRE <br /> r� UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> I� HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> ]� TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑ POOLISPA ❑ 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-5:00PM - 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 /> j 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 file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> j. Future file reviews by the same applicant may require a $98 .00 deposit prior to review. <br /> I <br /> EHD USE ONLY <br /> ** If you should need further assistance please contact bione Martinez C? (209)468 -3425 directly . Thank You*** <br /> i <br /> i <br /> V <br /> EHD 46.06 9/14/2006 <br />