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05 / 13 / 2008 09 : 54 FAX 2001 / 001 <br /> Iel <br /> DATER E V,E-b EHD LOO NUMBER <br /> IIS SAN JOAQUIN (,BOUNTY <br /> � IL 11=SIL \� l �J ENVIRONMENTAL HEALTH DEPARTMENT *Vmkb <br /> Y �. 3 2001 600 East Main Street, Stockton , CA 95202-3029 <br /> ItiF` Telephone; (209) 468-3420 Fax: (209) 464-0138 Web : www,sjgov.org/ hdS <br /> 0 <br /> E \IIERMUT /SFE�VIM PUBLIC RECORDS RELEASE APPLICATIO <br /> AFF , / `^ V^ � p <br /> APPLICANT: Il! \ I ES 5GUAW BUSINESSIAGENCY: 6n �rLOn S p �Vlas <br /> ADDRESS: -; 434 <br /> '13 y M a-fGoni /3v�C 4t8 L ,I <br /> PHONE (1 ): 416 NfGO OEO PHONE (2): FACSIMILE: RIG 41-8 0 (903 <br /> TENTATIVE" APPOINTMENT DATE: . Time. Uh1nQ <br /> (Please allow ten business days from date aF application submittal . •Tanfativo only - must bsoil <br /> wnSit er d) <br /> ❑ CHECK BOX TO EXPEDITE REQUU ST - 598. EE (CA 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 City ❑ unit s <br /> 1 • 70 '6 l/cM Ourw } OLIc} dil 4 <br /> 3. LI04 � rZMu/11 af* C�i�LdG µ Gr C /) ` 5,0 ko I FrI <br /> 4. Ll 2.K V W t31/ fPM Yv ] M1 ! L I�'Yd/1 �S off- 4� O 115 unit 9 <br /> 5. 405 ry 0r (Co2 Tddf �GLu $Fll /v � C� <br /> 6. ties GinGaln 5TLL_ /U . � r nit4 <br /> T 6t1 w retmo(lt <br /> 8. 0 Units <br /> 9. <br /> 1g nit 6 <br /> Specific Date Range Of Information Requested: From B e&4-1I [ Sd' to 20019 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NUNDERGROUNu TANK (UST) CLEANUP SITE (LOP) ❑ HOU&Nn AuATEMENT SOLID WASTE FACILITYNEHICLE <br /> aorrHER CLEANUP SITE (NON•LOP) O FOOD FACILITY WASTE TIRE <br /> IIUNDERGROUND TANK (MOMTORINGIREMOVAL) ❑ DOG KENNEL Q DAIRY <br /> q HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH M WASTEWATER TREATMENT PLANT <br /> (Z TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOOIBODY PIERCING C3 POOLISPA O LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AveiLADLE FOR REVIEW • MONDAY.FRIDAY 8:00 AM•3:OOPM . 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 (2091464-0198 or mail to the above address. Address ranges will <br /> not be accepted • for additional assistance with fila 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 H any EHD files exist. An appointment for review will be confirmed approximately ten <br /> days after receipt of application. The files will behold for a maximum of five business days for review. AppolntmantR <br /> should be scheduled accordingly. <br /> a. 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 retumed In the same condition as released will be reorganized 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 /> FHD 46-06 1012UT PUBLIC RECORDS RELEAREAPP FORM <br />