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A'�'MhffN' ' f x <br /> 304 Fast Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 <br /> AUG 3 2005 Telephone; {209)468-3420 Fax: (209)4 64-013 8 Web:www.sjgov-orglehd <br /> ENVI�DNMENT HEALTH 0000q <br /> 5 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: = BUSINESSIAGENCY: <br /> ADDRESS: DCC= d - rte, ca <br /> PHONE(1): 1�71/"7 -/Z 3 PHONE(2): <br /> �— FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please SHOW io business days from date of application submittal-"Tentafrve only-must be confirmed) <br /> E3 CHECK BOX TO EXPEDITE RE UES $93.0 <br /> 0 FEE( H OR CHECK ONLY)si / Y)--REQUEST PROCESSED•IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> 11 . DATE — <br /> , z <br /> UNR DISTRIBUTION13 Unit 1 O Unit 2 . 13 Unit 3 tilt Unit 5 0 Unit6 " Q Other(electron <br /> ic/listslmaps) <br /> FILE ADDRESS <br /> Street 9 S t Name city EHD USE ONLY <br /> 2. <br /> 3. l <br /> 4. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range ofinformation Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ONDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FAcnmlVemcm i <br /> tTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGRouND YANK(MoNmopiNWREMOYAL) ©DOG KENNEL C3 DAIRY <br /> 10 HAZARD06S WASTE'GENERATOR D C}PcK tH RANCH t7 WASTEWATER TREATMENT PLANT <br /> D TIERED PERMMED FACILITY ©MpTEI JIIOTEL ❑PUMPER TwcMARDICHEI4 TotLETs <br /> 10 TATTooMwY PIERCING '13 POOLISPA 0 LAND USE APPLICATIONSRES <br /> 0 MEDICAL WASTE FACILITY 6 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMT RECORDS ARE AYAR ABLE FOR REVIEW- F$ONDAY-FRIDAY S.00 AIDS-s:00P1a - EXCLUDING HOLIDAYS..- i <br /> z. List up to ten addresses',in the space above. Select the.type(s)of files from the list above by checking the <br /> appropriate bbx(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized b},�EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit.prior to'review. . <br /> _ n <br /> FItD 4s-02-046 - <br /> 11/23144 <br /> f <br />