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nug 1G 07 11 : 37a Ma Tyree Herbert <br /> �j (925) -3738 P. 1 <br /> 0 I p <br /> 5EHO LOG NUMBER <br /> SAN JOA,QUIN COUNTY <br /> ENVIRONWNTAL HEALTH DEPARTMENT <br /> A(/1^ 600 East Main Street,Stockton,CA 95202 <br /> Telephoune:(209)468-3420 Fax;(209)464-0138 Web;www_ 0 <br /> PUBLIC RIECORDS RELEASE APPLICATION <br /> APPI CAN Wd, „D n E E p-a E�T <br /> BUSINESSIAGENCY: VVnIZ <br /> I- <br /> ADDRESS:-- I S W./ PINE ST-. STS. g L-DDI <br /> PHONE(1y 7)-”)S B PHONE(Z): �9ZS) ZI FACSIMILE: <br /> TENTATIVE'APPOW"ENT DATE; 00 3 l —o'T <br /> (Please allow 10 business da1s fromdatp Oa GC3tienmnmQ' <br /> I O Crn <br /> bitTMbfiVe <br /> Only-muu be Confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-SIS 00 FEE(CASH OR CHECK ONL - EOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE g- I to-0-7 <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> 'I / Street Street Name t City _.._ <br /> 2040 w rVGLSh� C-L+-O✓1 100pellill <br /> �-o r� <br /> O 1 Z• Z 1 1 S 1� . wGLSI�i b✓� St. S�DG{�� ✓_ <br /> W Wall-ii -1a� S1 • Sfiock+on Unita <br /> s. Z3oS W. WaShi rl ton St. Stocic�o,� <br /> 6 2321 w. �asti� 4or\- ' Untt4 <br /> \^ 51-- St-oGk•bv-1 <br /> \' r 25210 W. 11Vas1�, 1ort Sr. St-oC"_t> Y-, -- <br /> s. 21050 W� 1V�/a ( � lovti St_ Sf ❑ unit s <br /> s. 2"100 W. V/ )a h; <br /> tin Sr. 5t-a�k�, <br /> < ' 10. 2`1 {`I w. 0.5 hl �r) Sr. S GILEoY 1 Unit 6 <br /> b" V Specific Date Range of Information Requested:From 2.1 I c laA-es <br /> to <br /> ENVIRONMENTAL,HEALTH DEPARTMENT FILES <br /> UNDER-MOUND TANK(UST)CLEAMM S1TE(LOP) r3 HOUSING ABATEMENT <br /> ,10—OTHER CLEANUP,SITE(Not-LOP F000FACIuTy DUD WASTE EACILITYN[NICLE <br /> "UNDc-RCRDuNo TAW(MowroRINWREMOVAL) II tB�o�c KENNEL ZWAsTE TIRE <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RAW24 DAIRY <br /> J�aj�•TIERED PERMH-FED FACILITY O MOTELIHOTEt, /0 WASTLWATER TREAnwNT PLANT <br /> /r-+TATTOwsoDY PIERCT1c ❑PDOLlSPA PUMPER TRUCKNARDIC lEM TOILETS <br /> 'P'MEDICAL WASTE FACILITY LAND USE APPLICATION SITES <br /> 0 OTHER(PLEASE SPECI Fy) <br /> WELL AND SEPTIC PERMIT REcoRDs ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 11:00 A":00pM - EXCLUDnrC HOLIDAYS, <br /> 1. List up 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 ba selected. Fax to <br /> ranges will not be accepted-for additional assis?ance w (yam-0f 38 or mall to the addr�Ind above Address <br /> 3:00 pm will be processed the next buslness day. addresses,contact the E}fD.Appllcatior,g received after <br /> 2. The END will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after recotpt of application. The files will be held for a maximum of five business days for revlow. Appointments <br /> should ba scheduled accordingly. <br /> 3. A filo that Is actively being wnrkod on by END staff may not he immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any file not returned in the same condition es released wfll be reorganized by END staff at the expanse of the <br /> Future file reviews by the game applicant may require a$95.00 deposit prior to review. applicant. <br /> END USE ONLY <br /> Er14 ti0-01 5/76/1401 <br />