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y.;yf�� ice.,;� "` 4 ww. 'Ik .�, �'� �`i <�c � � '_ -•a y ��.. - .. s.n <br /> '+.._ 5' ` ..yCC/1� m t," ny�i`�..'il.�wu=..%a'w1' +PL•i,X4:I .>,k �+w'xV`:-+�'y'Yi' +a -r•i A .k -'. Yipk }:.�r s/ <br /> j 1+ •i )a.�. s��:r�..11e�+;i. �3, <br /> "� f J0AQUIN COfiJ= <br /> no I��((� EN 1R0NMENTAL HEALTH DEPARTMMNT <br /> W`�v E N E D 304 East Weber Avenue, 3d Floor, Stockton,CA 95202-2708 <br /> AUIi 5 2005 Telephone:(209)468-3420 Fag: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENT 14PAI TW PUBLIC RECORDS RELEASE APPLICATION <br /> APDL rc7AIVT h he WS60 BUSINESSIAGENCY: 0CLYNca AM <br /> ADDRESS: <br /> PHONE(1): ` 7 — L� PHONE(2): �D.17 ` /I " d�-/ `� FACSIMILE: <br /> ATIVE*APPOINTMENT DATE: M aus, 'goo's, Time: Q!1 yor e <br /> (Please allow 10 business days from date of app tion submittal-"TenlatUve only-must be conflmted) <br /> CHECK BOX TO EXPEDITE:!!!�EST-183.00 FEE(CASH HECK NLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATEa,nAn <br /> off ot <br /> UNIT DISTRIBUTION Un@ 7 jFtinit2 ZIJnIt3 4UnIt4 affinItS 0 Unit$ 0 Other(electroniOistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City <br /> 1. b <br /> 2. �1 fl <br /> 3. N <br /> 4. r I{ <br /> s. e r v <br /> K— <br /> z. <br /> s. E Frenith Road <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to vivA <br /> ENVIRONMENTAL HEALTH DEPARTMENT PILES <br /> 3*DERGRoUNP TANK(UST)CLEANUP SITE(LAP) QUSING ABATEMENT 4) b SOLID WA&TE FACILITY/VEHICLE <br /> JTHER CLEANUP SITE{NON-LOP) OOD FACILITY ❑WASTE TIRE <br /> NDERoftowo TANK(MONITORINQIREMQVAi.) DOG KENNEL 13 DAIRY <br /> HAZARDOUG WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> •TIERED PERMITTED FACILITY 17 MOTELIHQTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> d TATTOO/BODY PIERCING ❑POOLISPA �4"o 113E APPLICATION STYES <br /> ❑MEDICAL WASTE FACILITY r-3 OTHER(PLEASE SPECIFY) <br /> WVLL AND SEPTIC P R CORDS ARE AVARA6LE FOR REVII VW- MQNDAY-FRIDAY 8.00 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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to(20914640138 or mall 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 hold 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 by EHD staff at the expense of the <br /> applicant. Future flle reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 46-024M <br /> �nnroe <br />