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no SEP-11-2008(THU) 13: 29 P. 00 1 /00 1 <br /> ATE RECEIVED EHD LOG NUMBER <br /> RECEIVED RO SAN TAL HEALTH <br /> COUNTY <br /> o ENVIRONMENTAL HEALTH bEPARTMENT <br /> • 1868 East Hazelton Avenue Stockton CA 95205-6232 <br /> • AUG 2 6 2013reiephone: (209) 458-3420 Fax: (209) 464-0138 Web: www.$)govorT1ejL. op y <br /> ENVIRONMENTALHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PFRAaITICFRI/I(:FS _ � <br /> APPLICANT-,—'S-Fe-fieBUSINESS/AGENCY: <br /> ADDRESS: '._L f t7 W eAlb W nob �)/2 f Uf ccCITY/STATE2IP: UI/ /�7 C5;bs^t <br /> PHONE(1): Crr(aPFV PHONE (2):2-© FACSIMILE: ` <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Plnaso 21low10 business days from data of application submittal-'Tonbtrlve only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST ZS FEES(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU NESS DAYS <br /> SIGNATURE OF APPLICANT eo� , dL4 -c DATE 5 13 <br /> Electronic information: E3 List['9-Map—Description: U �L / S <br /> FILE ADDRESS EHD USE ONLY <br /> Suoot S Street Name city Unit 1 <br /> 2. " V ve {rF1 bE���J �. Unit <br /> 3. z 1 IQ (V�02. (ts(oe� <br /> 4. t 1r �_ Unl13 <br /> , I ! <br /> S. ) b"!". GM ;4,1 (�,Ln f N�i 1GGkC,•: �y- _ r C2/� r(� re <br /> 6. sws 1�.��'K2 �'„ q ) ( �I� r L l z;n1 unua <br /> 7. "'t( <br /> Units <br /> c <br /> 10e <br /> 3) V, ❑Units <br /> Spocl fie Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT QWASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) tr❑--II F000 FACILRY ❑DAIRY <br /> lJ <br /> ❑ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLiSPA ❑LAND USE APPLICATION SITES <br /> EDTATToolawy PIERCING ❑COMPLAINTIRESPoNSE RECORDS ❑OTHER(PLEASESPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the typo(s) of files from the list above by chocking the appropriate <br /> box(es). At least ono filo typo MUST be selected. Fax to (US)454,0138 or mail to the addrogs indicated above. Address <br /> ranges will not be accepted-for additional assistance with filo addresses,contact the EHO. Applications received after <br /> 3:00 pm will be processad the next business day. <br /> 2. The EHD will notify the applicant If any EHD files oxist. An appointment for review wil b o need approximately ton (10) <br /> days atter rocelpt of application. The files will be hold for a maximum E)Ive busino review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on,by EHD staff may not be Imm .tely b or roviow. A now appileation may be <br /> submitted when the filo is available. <br /> a, Any file not returned in the same condition as releasad will be reorganized by EHD staff at tho expense of the applicant <br /> Futuro file reviews by the same applicant may require a$125 deposit prior to review. E70gtP liHl99LP <br /> 'Iatiw�4l�al' _.'nA.I�fraJ +L.� .t n ()�: r)°�' � "` ' �4"m*-w• l h5 k - m'WC' F'IM�Jn9 <br /> �R - w : u <br /> E] Records)ptovlded by„Steif„PPR",Completeser?Nano ,tr, ? `. a' . i,` =_" <br /> `Re'l 'ived Time Aug. 26. 2013 1 :42AM No, 3919 °fu” <br />