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10/07/2008 17:31 5306766005 STRATUS NO CALIF PAGE 01/01 <br /> 4' EHD LOG NUMBER <br /> L�{`�./' <br /> J�'(� SAN �10AQUlN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARIMENT <br /> 0 Cl (; ��Q8 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)4640138 Web:www.sj V,,r <br /> ENVIRONMEN T HEAUH <br /> PUBLIC RECORDS RELEASE APPLICATION �, Y�6 <br /> APPLICANT: 4uS ��tYov) vtT4+� ; �C BUSINESSIAGENCY: ��� <br /> �' PiksSo citylStatelZlp <br /> ADDRESS: 3 <br /> 3 13- '�D�i (cc1i� FACSIMILE: soum.- <br /> PHONE(1): (530 S+s 4' 611 �rfkce.) PHONE(2): �-1�sl <br /> TENTATIVE"APPOINTMENT DATE:, <br /> t Time: <br /> (pleass allow 10 business days from date of application submittal-*Tentative only.must ba confirmed) <br /> C1 CHECK BOX TO EXPEDITE R ST-$105 EEE( SH OR CHECK ONI-Y)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF,APPLICANT <br /> DATE <br /> Electronic Information: [] List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> : Street# Street Name City � Unit 1 <br /> vJ, '1 �CV-� n <br /> 1�CirY1 YiF1ei )-cute ❑ Unit 2 <br /> < kaciCl�n � <br /> 3. nit <br /> 4. <br /> X_ \ <br /> S. Unit4 <br /> ie <br /> 29 6. <br /> 7. <br /> 8. <br /> ❑ Unit 6 <br /> 9. <br /> 10. <br /> lGlal°I to p:ese•�t <br /> Specific Date Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> HOUSING ABATEMENT CI SOLID WASTE FACILITYIVEHICLE <br /> UNDERGROUND TANK{UST)CLEANUP SITE(LOP) C3 FOOD FACILITY 173 WASTE.TIRE <br /> 0 OTHER CLEANUP SITE(NON-LOP) Cl DOG KENNEL O DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> Ct HAZARDOUS WASTE GENERATOR C3 MOTE11�+HoTvL b PUMPER TRUCK/YARDICHEM TOILETS <br /> El TIERED PERMITTED FACILITY CI POOUSPA E3 LAND USE APPLICATION SITES <br /> C3 TATTOOIgODY PIFRCING ❑OTHER(PLEASE SPECIFY) <br /> 13 MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00rM - EXCLUDING HOLIDAYS- <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 4fi4-0138 or mail 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. approximately ten 10 <br /> 2 f any EHD files exist. An� <br /> dayEHD will not4 s after receipt a application.applicant IThe files will be held for a maxi um of five businessointment for Idays for reviewbe confirmed .Appointments { ) <br /> y p PP <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 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. <br /> Future file reviews by the same applicant may require a$105 deposit prior to roview. <br /> EHD USE ONLY <br /> PUBLIC RECORDS RELEASE APP FARM <br /> EHD 41-06 8104108 <br />