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av �• LVv7 -r V71In i7LLIIII LLULI] nV. I)LLt I . I <br /> DATE r-HD Lvu ridWER <br /> ��[C��� VEL�� SAN JQAQUIN COUNTY <br /> 41 EMNVIRONMENTAL HEALTH DEPARTIVI <br /> NOV 0 9 2009600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax; (209) 464-0138 Web:vrww.sjgov.or <br /> ENVIRONMENT HEALN PUBLIG RECORDS RELEASE APPLICATION <br /> r APPLICANT: BUSINEWAGENCY: G f ^ <br /> ADDRESS: CltylStatalrlp <br /> PHONE(1): PHONE(2); FACSIMILE: C1 t , --7CW5 <br /> TENTATIVE'APPOINTMENT DATE:„ _Time:Time: <br /> (Please allow 10 business days from date of appllt+ tion submittal-'Tentaflve only-must bo confirmed) <br /> !� CHECK BOX TO EXPEDITEU $ 05 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> JC) le <br /> EST <br /> SIGNATURE OF APPLICANT DATE <br /> vv <br /> Electronic information. (] List❑ Map—Descrlptlon: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# l $tregt Namo Ci <br /> ( ,croft 1 <br /> M4,0 C" Mf <br /> LjA;,It 2 <br /> 2. <br /> 3. ` 0 .Unit3 G� <br /> 5. ❑ Unit 4 <br /> 7. 1FVA V1j ❑ Unit S <br /> 8. o <br /> y 1-19 <br /> s. ❑ Unit c <br /> 1 D. <br /> Specific Dat$Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPART7rIDAIRY <br /> 'ERGROUND TANK(UST)CLI_ANUP SITE(LOP) C3 HOUSING ABATEMENT STE FACILITYiVEHICLE <br /> ER CLEANUP ESTE(NON-LOP) tl FOOD FACILITY RE <br /> VVER3ROUNDTANK(MONITORINOIREMOVAL) ❑DOG KENNEL AZARDOUS WASTE GENFRATOR la CHICKEN RANCH TER TREATMENTPLANT <br /> M TIERED PERMITTED FACILITY 0 MOTELIHOTEL. RUCKIYARDICHEM TOILEM <br /> 11 TATTOOISODY PIERGIN<3 C3 POOLISPA APPLICATION$Iris <br /> ❑MFNCAL WASTE FACK.11V ❑OTHLR(PLEASESPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOA RSVIEW - 61 iONDAY-FRIDAY B:OO Ari• EXCLUDING tlA <br /> 1. List up to ten addresses in the space above. Select the typo(s)of files from the list above by checking the appropriate <br /> box(es). At least one fila type MUST be selected. o ?09)464-PI38 or MAj1jojU g0dress inc e bove. Address <br /> ranges will not be accepted—for additional assistance with flio addresses,contact the EHD. Applications received after <br /> 3.00 pm will be processed the next business day, <br /> 2. The RHO will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten('10) <br /> days after mcelpt of applicatlon. 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 EXD 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 exponse of the appilcant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 49-06 W04108 PUBLIC RECORDS RELEASE APP FORM <br />