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DATE RECFIVED EHD LOG NUMBER <br /> 'otmain <br /> UST CUUN'�'X <br /> �� �I �l LOU HEALTH DEPA "X'1VkN' <br /> I R I� _� <br /> Street, Stockton,CA 95202-3029 <br /> FEB � 1 2008 Telephone: (209)468-3420 Fag: (209)464-0138 Web: www.sjgc345fo <br /> v,o e <br /> u ji�' i�T HF-P,I-I PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT: �i�.�/�R •� ��fef/ BUSINESSIAGENCY: Lt,t, 6d-a je cer T-4 it <br /> PHONE(1):�/l/- 1i'Gl~ 1?,?r0 _PHONE(2): 9 Y{f FACSIMILE: <br /> Apr <br /> TENTATIVE`APPOINTMLNT DATE: Time: 07 <br /> (Piaasa allow 10 buainase days from data of application submittal-`Tentative only-must be conflrmq4 &4 <br /> CHECK BOX TO EXPEDITE RCOVEST .00 FE (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS <br /> SIGNATURE OF APPLICANT R _ _ rf" DATE .2_A.1/0& <br /> Electronic Information: Q List©Map--De*cription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street fF Street Name city ❑ Unit 1 <br /> 2. ] Unit 2 <br /> 3. 7 ❑ Unho: <br /> 4. _ <br /> 5. <br /> U <br /> 6. <br /> 7. ❑ Uait 5 . <br /> 8. 46 <br /> 8. <br /> lj unrt s <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPAR ENT FILE$ <br /> ID UNDERGROUND TANK(037)CLEANUP SITE(LOP) ❑HOUSING ABATFMENT ❑SOLID WASTE FACIUTYNEHICt.E <br /> 10 OTHER CLEANUP SITE(MOM-LOP) 0 FOOD FACILnY O WASTE TIRE <br /> C33 UNDERGROUND TANK(MONITOrtINGIREMOVAL) In DOG KENNEL 0 DAIRY <br /> 13 HAZARDOUS HASTE GENERATOR 13 CHICKEN RANCH D WASTEWATER TRE=ATMENT PLANT <br /> TIE FMP pJERrd)TTED FACILJTY ❑MOTELJHOTRL Q PUMPER TRUCK/YARD/CHEM TOILETS <br /> TA1ToolB04Y PIERCING C]POOLISPA M LAND USE A LICATION SITES <br /> E3 MEDICAL WASTE FACILITY Q OYNER(PLEASE SPECIfY)__._._-_.._ .a -a h-:I/o.) L C= <br /> WELL AND SEPTIC PERMIT RE=CORDS ARE AVAILABLE FOR ReVIEW - MONDAY-FRIDAY H:00 AM-6:00PM - E='UDING HOLIDAYS. <br /> I. 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(ea), At least one file type MUST be selected. Fax to(209)464-0138 or mall 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 waren 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, <br /> Future file reviews by the some applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHa -.�aa�r•--- u. <br />