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NOY. 9. 2009 4:09FM KLEINFELDER NO. 7524 P. 1 <br /> I?AT <br /> F!.I LHD Lvu+vWM6ER <br /> � SAN .10AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> t�t1V Q 2009 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web.www.sjgov.or <br /> ENV! 0�0hAIT!QIPR WES �� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> BUSINESS/AGENCY: V= { <br /> �t <br /> ADDRESS: ` Citylstato/Zlp <br /> PHOtlE(1): ��lD'JtQ�"l�O <br /> PHONE(2): FACSIMILE: C FJ —1015 <br /> r <br /> TENTATIVE"APPOINTMENT DATE: } yjloy _Time; tonw <br /> (Pleaw allow 10 business days from date of appil tion submittal-•Tentativo only-must he confirmed) <br /> ❑ CHECK BOX TO rcxPEDiTE VEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1O <br /> Electronic Information: ❑ List❑ Map--Description' <br /> FILE ADDRESS EHQ USE ONLY <br /> Street 0 Stroat Name Ci © Unit 1 <br /> . 2 wo C� f <br /> 2. nit 2 <br /> 3. Mf <br /> Unita G� <br /> b t ❑ Unit4 <br /> s. C", ` <br /> 7. j ❑ Unit 6 <br /> r� <br /> Unit 6 <br /> id• <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMEN�AgTrn <br /> 'ERGROUND TANK(UST)CLEANUP SITE(LOP) IM HOUSING ABATEMENT ID WASTE FACILRYNEHICLE 1 <br /> cR CLEANUP SITE(NON-LOP) r FOOD FACILITY RE <br /> NDERQROUND TANK(MONITOMNA1REMOVAL) D Dob KENNEL DA1RY <br /> AZARDOUS WASTE GENERATOR M CHICKEN RANCH ❑W EWAT6R TREATMENT PLANT <br /> C3 TIERED PERMITTED FACILITY 13 MOTEIIHOTEL 0 MPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTooIBODY PIERCING ❑POOUSPA 10 LAND USE APPLICATION SITI•S <br /> 173 MEDICAL WASTE FACILITY 171 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PCP)A17 RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM' jr1 - EXCLUDENG I IDAYfi <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the listabove by checking the appropriate <br /> box(es). At least one fila type MUST be selected. Fax to(209)464-0138 or m011te th.0 8lddmss lnd,)cated.ab_ove. Address <br /> ranges will not be accepted—for additional assistance with filo 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 behold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3, A flee that is actively being worked on by FHD staff may not be immediately available for review. A new application may be <br /> submitted when the fife is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the exponse of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> PUBLIC RECORDS RELI=ASEAPP FORM <br /> EHD 48-00 8!04109 <br />