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T � � EHD LOG NUMBER SAN .1QAGlUI N BOUNTY <br /> �] ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP Q 3 2048 600 East Main Street, Stockton, CA 952023029 <br /> Telephone: (209) 468-3420 Fax: (209),464-0138 Web:www.Sjgov.or /e <br /> ENVIRONMENT HEAEIK <br /> PER RV1GE5 PUBLIC RECORDS RELEASE APPLICA N <br /> APPLICANT: aiAvl BUSINESSlAGENCY: <br /> ADDRESS: 902 IndoiaL __au. Clty►Srerorlp -Lgdi, CA-9,5240 <br /> PHONE(1): - PHONE(2): FACSIMILE: 209- 69-4228 <br /> TENTATIVE*APPOINTMENT DATE: .. -6- Time: <br /> (Please allow 10 business days from date of Application submittal-*Tentative only-must be Confirmed) <br /> C_ HECK BOX TO EXPEDITE REQUEST $106 FE ASH OR CH£CI(ONLY)-REQUEST PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: 0 List[] Map--Descriptio&—' <br /> FILE ADDRESS EHD USE ONLY <br /> Streat V Street Name _ City ❑ anti 7 <br /> 2. � � t3 ❑ Unit z {� <br /> 3. o�-� l Sad v� <br /> 41 /"UnitS <br /> 5. <br /> 6. Unit 4 <br /> 7, <br /> ❑ unit 6 <br /> 8, <br /> 9. <br /> - CI <br /> units <br /> 10, <br /> Specific Date Range of Information Requested:From � to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L <br /> RRROUND TANK(USTI CLEANup$1T$(LOP) ❑HOUSINd ABA trAvNT Ia A.CUD WASTE FACILITYA/EHICte <br /> R CLEANUP SITE(N6N-LOP) ❑FOOD FACILITY (�WASTE TIRERGROUNDTNK(fdIDNImmilo1REMaVAL) Q DCC KuRNCL Q DAIRY <br /> RDOUSWASTEGENERATOR10 CHICKPN RANCH 13 WASTEWATER TREATMENT PLANT <br /> ROP RMRTEDFACIUTY IaMOTELIHOTEL 0PUMPER TRUCKIYARo/CmEmTOILm <br /> a TATTOOlBODT PIERCING C3 POOLISPA ❑LAND Use APPUCA=N SITES <br /> CI MEDICAL.WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> WDLL AND SEPTIC PERMIT RecoADS ARE AVAILARLs roR REVirw- MONDAY-FRIDAY 8:00 AM-6:00PM , FxcLUMNG HOLIDAYS. <br /> 7. Ltst up to ten addresses In the space above. Select the typa(s)of flies from the fist above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0149 ojjnali to ffie.address Indica#ed above_._ Address <br /> ranges will not be accepted-•for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will be processed the next business day, <br /> 2. The EMD will no#lfy the applicant If any EMD files exlst. 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 attordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any fife 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$106 deposit prior to review, <br /> EHD USE ONLY <br /> EHD45.06 8!04108 PUBLIC RECORDS RELt-ASE APP FORM <br />