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DATE RECEIVED SAID .10�1QUIN COUNTY FWD t o�NL�IueER <br /> i <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> i 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209).468-3420 Fax, (209) 464-0138 Web: www.sjgov.0r ehd 3q 7 <br /> E PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1.14 * u31Nl:S GENCYr ,�J>r"-4�. ra;, �( t <br /> Al7URES5: gal o� � tom' , !/ <br /> TP_NTATIVE*APPOINTMENT DATE: /4 �� _ <br /> Timm Q . <br /> E (Pleaso allow ton business trays fr m dat of application subthittal-•TenfetiVe only-must be confirmed) <br /> t <br /> CHECK BOX TO EXPEDI EST 90.0 F CASH OR c ONLY)-REOUEST PRacl:SS1=D M THRE b (NESS DAYS <br /> SIGNATURE OF APiaLICANT - DATE <br /> Electronic Information: List❑ Map �Description: <br /> FILE ADDRESS EHD USE ONLY?, <br /> _ 5tra0t>ie _�LL Street Nama --- .� City - Unit 1 <br /> 3' <br /> 4. ?� <br /> 5 <br /> A. .-UM 1t.4" <br /> 7. mm_ <br /> A . <br /> t3• ¢ O Limit 5 <br /> 10. d unit 6 <br /> Specific tate Range a Infannation Requested- from to <br /> �,, <br /> // ENVIRONIVIENTAL HEALTH DEPARTMENT FILES <br /> *40ERGROV'ND TANK LUST)CLEANUP SITE(LOP) f=1 HOUSING ABATEMENT CI SOL16 WASTE FAciLITYNEHICLR <br /> C3 OTHER CLEANUP SITE(NON-LOP) ©FOOD FACILITY 0 WASTE TIRE <br /> CI UNbEAGROUND TANK(MONITORINGIRFMOVAL) ❑DOG KBNNEL . O DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR C1 CHICKEN RANCH. d.WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL114OTPL 0 PUMPER TRucKIYARDICHI:M TOILETS <br /> ❑TATTOOIBODY PIERCING 11 0001-19PA 0 L ANC LISP APPLICATION SITS9 <br /> MEDICAL WABTE FACILITY 0 OTNl_R(PLEASE SPECIFY) <br /> WELL AND SEPTIO PERMIT RECORDS ARE AVAILAaLE FOR REVIEW -'MONDAY-FhIDAY Boll ANI.5,,UopM • EXCLUDING HOLIDAYS. r <br /> 1. List up to telt 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'type MUST be selected ax to 209 464-0138 or mall to the above address: Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the 1rMb, Appilcations received after 3:00 pm will <br /> be processed the next business day. <br /> 2, The END will notify the applicant if any EHD tiles exist. An appointment for review will be confirmed approximately ten <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 the EHD 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 RHD staff at the expense of the applicant. <br /> Puturfp flip reviews by thp s grit--applicant may require a$98,00 deposit prior to review. - <br /> EHD USIr ONLY <br /> EFfo 4A-n1 ;nr}�In� PUR41C REGDRD EASE APP FORM <br />