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CN <br /> G NUMBER <br /> �} �f(-- �1 SAN .TOAQUrN COUNTY ... <br /> �1 '� 1 ENVIRONMENTAL HEALTH DEPARTMEN <br /> SEP 1 1 2008 600 East Main St. Stockton, CA 95202-2708 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sj ov.org/elid <br /> [ i <br /> aERt� T/SERVICES PUBLIC RECORDS RELEASE APPLICAT <br /> APPLICANT: Cp ` 4 n C-C- k T AUSINESSIAGENCY: <br /> ADDRESS: ``r i we'd CITYISTATE2IP i°� <br /> PHONE(1): - PHONE(2): -ZZ <br /> C� FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-"Tenfative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQU T-$105.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 a WE DAYS <br /> SIGNATURE OF APPLICANT DATE / !� <br /> Electronic Information: ❑ List ETMap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> ,tE.T7f 0 �: -C P_ .100 <br /> D <br /> 2. (�P Y� CO'V b 1�O c� Unit 2 Q}�I <br /> 3. o f—_ <br /> ❑ Unit 3 <br /> 4. <br /> 5. - ❑ Unit 4 <br /> 6. <br /> 7. ❑ Unit 5 <br /> 8. <br /> 9. ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 17 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 11 SOLID WASTE FACILITYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br /> 0 UNDERGROUND TANK(MONITORINGIREMOVAL) 11 DOG KENNET. 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH 11 WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 13 MOTEL/HOTEL El PUMPER TRUCKIYARDICHEM TOILETS <br /> 13TATTOOIBODY PIERCING 13POOLISPA LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY$: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 /> 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 END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diene Martinez @ (209)468-3425 directly. Thank You*** <br /> ft--&- 1 of c CA,i{ f( Q S-- L.{(. �¢tir li i �Ee✓.e� i+ ! <br /> ?q-T _ <br /> t <br /> F"n 6RAR A1RGl7f1fYR <br />