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RECEIVED E.—,110NMENTAL HEALTH '9077077'0� :'T S�H 'fl '2nV ;,Ali P;A I ;I <br /> 1868 East Hazelton Avenue, Stockton, CA 95205--6232 <br /> AUG 10 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd ' I <br /> NVIRONMEPUBLIC RECORDS RELEASE APPLICATION <br /> ENF�-11 'IFTH <br /> PERM <br /> APPLICANT:• h , Aj4_C��_ qUSINESSJAG;ENCY- V T4-t A ce f I it <br /> ADDRESS: . -;,' L; _,�t <br /> 14S CITY/STATE/ZIP: FT-Pao . 0-h <br /> ,�j((�X AL)E._�j 1(o <br /> 37 <br /> PHONE(1): 65�jq !j9q-4j21(_ PHONE(2):SCk�tc_tj CUO FACSIMILE: <br /> Pleas allow 110 business <br /> day from date of application submittal for the records to be available. <br /> 's <br /> Staff will contact you to arrale an appointment date and time to review the requested records. <br /> F-1 CHECK BOX TO E(PEDI REQU - FEE C;��ONLY)-REQUEST PROCESSED IN 3®LI (NESS PAYS <br /> SIGNATURE OF APPL� DATE <br /> Electronic Information:' El List[I Map-De4cription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street Name c Ity ❑ <br /> _ 700 !� , Seln. <br /> 2 <br /> F. )Cid 0 unit 2 <br /> 3. <br /> 4. t& t1 Ln QEl Unit 3 <br /> 6. El Unit 4 <br /> 8. F1 Unit 5 <br /> 9. <br /> L10' Unit 6 <br /> Spgclfc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �R <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACiLrry ❑SOLID WASTE FAC0.11TYNEHICLE <br /> n OTHER CLEWR SITE(NON-LOP) ❑HOUSING ABATEMENT Ej WASTE TIRE <br /> allNE) mo TANK(MONITOFMG!RM)VAL) ❑F000 FACILITY []DAIRY <br /> =VEmD TANK Cj CHICKEN RANcW DOG KENNEL E]wAsTEwATER TREATk"T PLANT <br /> ITAzARDM WASTEJKA2ARDOUs MATERIALS ❑MoTamwa ❑PU%M T RUCK[YAPsOCHEmicALTouTS <br /> PWJSPA ❑ <br /> ,ED PERwTrED ACILAND USE APPLICATION SITES <br /> IEF TATTOOfBODY PIERCINGFLffY "Iffr #a/ APPLICATION RECORDS E]OTHER(PLEASE SPECIFY) <br /> WELL AND sEP-ncPERmff RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PIA (EXCLUMGHOUDAYS) <br /> 1, Ust uR to ten address—as in the space above. Select the type(s)of files from the Ilsf above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0115 or mail tO the address Indicated above. Address <br /> ranges will not be accepted.APPlir-atiOns received after 3:00 pm will be processed the next business day. <br /> 2. For assistance In Identifying the nature and content of EMD records,please contact EHD at the number rKA8d above. <br /> 3. The EHD will notify the applicant if any EHD files exist 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 accordingly. <br /> 4, Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant <br /> 1130 deposit prior to review. —130)(EpAREA-EHD USE ONLY"- <br /> Future file reviews by the same applicant may require a$ <br /> LID -&t (0 00 <br /> 0 Records provided by Staff-PPR Complete.staff Name: OMWM4 <br /> EHD 4$-M <br />