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10/.02/2008 10: 17 FAX <br /> la 001/001 <br /> DA iI `ir 1 EHD LOG NUMBER <br /> : („ ,,� [D, :� SAN .JOAQUIN'dOUNTY <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 0 C T 2 2008 600 Last MBIn Street, Stockton, CA 96202-3029 <br /> Telephone: 209 468-3420 fax: 209 4 - <br /> P { ) ( ) 64 01.38 Web. wwvr.sJgov.org/ehd <br /> ERIVI13COOBT HEALTH <br /> ' P RNIIIT/SERVICES PUBLIC RECORDS-RELEASE APPLICATION <br /> APPLICANT: SUSINESSlAGENCY: <br /> ADDRESS: V C1tylStatolZip !le Q <br /> PHONE(1): Iq L4PHONF(2)• FACSIMILE: <br /> TENTATIVE"APP01KTNfENT DAT Timo: ; <br /> (Please allow 10 buslness day ro date4GASR <br /> tion submittal-"T9nfative only-must b conflrmad) <br /> CHECK BOX TO EXPEDITE R QU O6 FEE ONLY)-REQUEST PROCESSED IN 2 BUSIN S HAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: Q List Map^DeScrlpt on: <br /> i <br /> 3 <br /> FILE.ADDRESS EHO-USE ONLY I <br /> Street# Street Name Ci <br /> 1. .Q -K056- Q It9 <br /> z. 02 <br /> 0 I'A IF unit 2 o <br /> 3 . <br /> 4. �F Unit 3 <br /> i <br /> 5. . <br /> � V-0 c- <br /> invn <br /> 10 <br /> T' t ` _ Unit 5 <br /> 9' unit 6 <br /> aa. Oc�a. " At- <br /> Specific <br /> Date;RsAge of Information Requested:From I c1H Q I to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tAPARDOUS <br /> ERGROLjNo TANK(UST):CLEANUP SITE(LOP) d HOUSING ABATEMENT �D WASTE FACILITYIVEMCLE <br /> ER CLEANUP SITE(NON-LOP) _ la FOOD FACI4ITT TE T1RB <br /> ERGROUNOTANK(M4NITaaINGIREMOVAL) ❑ DDG KENNEL AIRY <br /> _ WASTE GENERATOR d CHICKEN RANGN. STEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑MOTEUHATEL MPER TRUCWYMOICHEM TOIL09 <br /> TATTOOISODY PIERCING C3 POOVSPA 0 USE APPLICATION SITES <br /> M ME9ACAL WASTE FACILITY- " - OTHER(PLEASE SPECIFY)_,_„„ <br /> WELL AND SEPnc PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 9:00 AM-8:00pM -ExccuoiNo HOLIDAYS. <br /> I <br /> 7. 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 typo MUST be selected- Fax to(2091464-013U r mail to thea t1 ss indicated a 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 Bppllcant if any EHD files exist. An-appolntmont 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 filo that is actively being worked on by EHD staff may"not be Immediately avoilabie for review. A new application may be <br /> submitted when the file is available. <br /> 4, Any filo not returned In the same condition as released will be reorganized by EHD staff atthee-expense of tho applicant. <br /> Future ills reviews by-the same applicant stay require a$105 deposit prior to review; <br /> EHO USE ONLY <br /> EHD 4e-06 9104lp9 PUBLIC RECORD$RELEASE APP FORM <br />