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05/10/2002 09:54 9164463803 MATT PAGE 01 <br /> `1"K <br /> DATER CEIVED <br /> SAN.1pAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT '� <br /> 600 East Main Street Stockton, CA 95202-3029 �`� <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sjgov.org/e d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; Mtq-7 ��q(~`("Y BUSINESS/AGENCY: D � <br /> ADDRESS: — (/ q�-?=.SU W �l 5'I<'z4""1Eni/ 7 <br /> PHONE(1): T G 'IL}(' ~�eoJ3 PHONE=(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: S-2-q'-ce Time: G1 R-1 <br /> (Please allow ten business days from date of application submittal-•Tentative only.must be confirmed) <br /> © <br /> CHECK BOX TO EXPEDITE REaUEST-99 DO FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street# Street Name Clry ---'-- Q Unit 1 <br /> 1 (30 5 5T-oCrc7tiJ <br /> 271160 ---I --yVS A-V) }Yu S iAt1CNKi�tOGrJ,� 355c,3f.r,;y Xe 6 <br /> e6 Ifo� <br /> ❑Unit2 <br /> 3- l1 13 Rd 3 <br /> / _"t <br /> 4. 5Z)Clc<`l>j �/--/ Unh3 <br /> 6. <br /> s. jot l Unit 4 <br /> 7. <br /> CXv.,._ ':55.7- ? Lo -2 unit s <br /> 9._ <br /> 10. <br /> I <br /> Specific Date Range of information Requested:From CL- to +4 P2,55Crv; <br /> }.� ENVIRONMENTAL HEALTH DEPARTMENT FiLES <br /> p�,l/UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 71 HOUSING ABATEMENT 0 SOLID WASTE FACILITYlVEHICLE <br /> P OTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY CI WASTE TIRE <br /> 1.>1�f UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ,4S HAZARDOUS WASTE GENERATOR l�CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> .2 TIERED PERMITTED FACILITY 13 MoTEUHOTEL ❑PUMPER TRUCKfYARDfCHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 0 POOUSPA t,,,,� LAND USE APPLICATION ITES� <br /> 0 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) F(L//nr+U(i QJ^l,g -7 Ts! <br /> 9r ? (21t40E <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(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 above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <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 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 same condition as released will be reorganl"d by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHo 49.ac 10129107 <br /> PUBLIC RECORDS RELEASE APP FORM <br />