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09/26/2008 ]4:49 FAX 559 442. 5081 KLEINFELDER 002/002 <br /> t I <br /> SRN] Jf��1�UIN COUN1 EHD Loc NUMBER <br /> SEP 6 ZOOS ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ENVIRONME-111T MEQ' lephone: (209) 468-3420 Fax: (209) 464-0138 Web: vVWW.Sjgov.org/ehd <br /> pFRtvitiSr. VIC,E-S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �, '.-''1<-�lC''�' � 1 { / f 1 1 BUSINESSIAGENCY: <br /> "; <br /> PHONE(1): ;'?�: f,75�'7 ��' L PHONE(2): (,,q 7 %ti' I. FACSMIHLE: <br /> TENTATIVE`APPOINTMENT DATE•: Time; <br /> {Please allow ten business days from date of application submittal-'Tentative only-must be confirmed} <br /> CHECK BOX TO EXPEDITE REQUEST-$98.60 FE�(CASH OR CHECK ONLYI-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List[j Map-Description: <br /> FILE ADDRESS EHD USE. <br /> � ONLY <br /> Street Street Name City <br /> ❑Unit 1 <br /> �. <br /> 2. <br /> 'AP-e N. r. 1 <br /> 3. <br /> 4. .( a i - )�` Unit a �D <br /> 7. <br /> 8. - <br /> nit 5 <br /> 10 I ; Unit C, <br /> I iL <br /> Specific Date Range of information Requested: From _ �'•�. \ •,,„„ to <br /> ENVfRONMENTAL HEALTH DEPARTMENT FILES 1 _ <br /> UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) ,-u HOUSING ABATEMENT ❑SOLID WASTE FACILITYWEHICLE <br /> THER CLEANUP SITE{NON-LOP) ❑FOOD FACILITY 0 WASTE TORE <br /> UNDERGROUND TANK(MONITORINsIREMOVAL) ❑DOG KENNEL CI DAIRY <br /> rAZAROOUS WASTE GENERATOR L'7. CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ;, l IEREb PERMITTED FACILITY ❑MOTELIHOTE4 0 PUMPER TRUCIdYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA Q LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMST RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - IaXCLUDiNG 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 4.64-0138 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file 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 if any EHD files exist. An appointment for review will be confirmed approximately ten <br /> days after receipt of application. The files wilt 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 the EMD 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 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 $98.00 deposit prior to review. <br /> j — EHD USE ONLY <br /> 5 HD 48.06 10129107 <br /> PLISLIC RECORDS RLLEASE APP FORA <br />