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vu ivicvva 10.4L rnn U001j001 <br /> DATE RECEIVED _ EHD LOG NUMBER <br /> ENVIRONMENTALOUNTY <br /> HEALTH DEPARTMENT <br /> FEB f7aQ� 600 East Main Street, Stockton, CA 95202-3029 <br /> elephone: (209)468-3420 Fax: (249)464-0138 Web: www.sjgov. <br /> ENVIRONMENTHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> ERMITSER. <br /> e <br /> APPLICANT:: BUSINESSIAGENCY: Ertereon <br /> ADDRE88: 3q?A ►-1CU-(� 1 � t�G. CIty/Statalzlp �SQ '___-ra A CA I <br /> PHONE 0): a!�� Q� � PHONE(2): �' a FACSIMILE: /161 <br /> nom_LAU~ CW3 <br /> TENTATIVE*APPOINTMENT DATE: bru a/ 8kE5 Time: I Q MI . <br /> (Please allow 10 business days from date of application tubmittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE d 10'aw9 <br /> Electronic Information: ❑ List[I Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> StroQt lk Street Name City Unit 1 <br /> F. mc�An si-ree,4 n7l-3 15 1?Cr jo <br /> 2. Unit 2 <br /> 3. <br /> 4. / Unit 3 �l� <br /> 5. N, <br /> Unit 4 <br /> 6. <br /> T' 5 <br /> 8. <br /> )�Init <br /> 9• _ C�Jnit 8 <br /> 10. / <br /> Specific Date Range of Information Requested:From ±�Col to Cu- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITY(VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILTTY WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL AIRY <br /> HAZARDous WASTE GENERATOR CHICKEN RANCH r1MpEgTRUCrARD/CH8MTOILE <br /> ASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILmI MOTIEUHOTEL TS <br /> TATTOOIBODY PIERCING POOLISPA D USEAPATION SITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyIE.W - MONDAY-FRIDAY 5:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. 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 type MUST be selected. Fax to(2091484.0138 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. <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 now application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned In the same condition as released will bs 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 review. <br /> EHD USE ONLY <br /> Fun ARAR R/nwoa PUBLIC RECORDS RELEASE APP FORM <br />