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DATE RECEIVED SAN .1QAQUlN COUNT L E �OPY <br /> EHD LOG NUMBER <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> MAR 2 6 NII Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> EN116RONMENTALH SLTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_y= ,_ Run, BUSINESS/AGENCY: %..a Sg.r, <br /> ADDRESS: C CITY/STATE/ZIP: �a C-A gyg-xk <br /> PHONE (1): (a1L)Lkt0-0236 PHONE(2):� 3oo�z�1- 3�1'�� FACSIMILE: tE1 �kQO—o(�o3 <br /> TE ATI "APPOINTMENT DATE' Time: <br /> (Please allow 10 buslnebs days from date of application submittal-*Tentative only-must be conflrmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST 125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT k / DATE #hO4 ;23 'W I2- <br /> Electronic Information' d List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 3vect N Street Name City H 1 <br /> VK2. 'zz`k% STf1G coA�-h1 Rc� j 0E-P',1dG>C nit2 <br /> 3. i <br /> 4. Unit 3 $' <br /> 5. <br /> 8 Zunit 4 <br /> S unit 6 <br /> 9. <br /> 10. Unit e <br /> Specific Date Rango of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES [91ASTE <br /> P'[INDERGROUND TANK(UST)CLEANUP SITE(LOP) MOUSING ABATEMENT LIDLID WASTE FACIVTYNEHIC<E .S <br /> PtTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY TIRE <br /> PONDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNET_ ❑DAIRY a <br /> ZARDOUS WASTE GENERATOR ❑CHICKEN RANCH � STEWATER TREATMENT PLANT t <br /> TIERED PERMITTED FACILITY [DVOTEL/HOTEL C. LIMPER TRUCK/YARD/CHEMICAL TOILETS v <br /> 0 TATTOOIBODY PIERCING LISPA OfAND USE APPLICATION SITES <br /> Q'MEDICAL WASTE FACILITY LIeLOMPLAINT RECORDS Qr 15THER(PLEASE SPECIFY) --r �+ <br /> WELL AND SEPTIC:PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List tAy to ten addressee 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(2091464-0134 or mail to the address indicated above. Addrese <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after � <br /> 3:00 pm will be processed the next business day. ' <br /> 2. The END will notify the applicant if any END 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. „ d' <br /> 3. A file that is actively being worked on by END staff may not be immediately available for review. A new application may be -� <br /> w <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 expense of the applicant. v <br /> Future file reviews by the some applicant may require a$125 deposit prior to review. <br /> !-HG USE ONI Y <br /> EHe 48.06 arvtt <br /> 100/10018 XVj 61 :91. Z10d/GZ/EO <br />