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11/30/2009 11:54 FAX 1� 002/002 EHD LOG NUMBER NOV 3 Q 209 ENVIRONMENTAL HEALTH DEPARTMENT {� 600 East Main St. Stockton, CA 95202-3029 E�1�j�iUN Rv� done: (209) 468-3420 Fax: (209) 464-0138 Web: www,sigov.org PERMff1� PUBLIC RECORDS RELEASE APPLICATION APPLICANT:PSS BUSINESS/AGENCY: 1or-Ts ADDRESS: ��{��{ � o� Iyy , CITY/STATE/ZIP: 9M2-/ PHONE(,): PHONE (2): (9k) -2-0/6 FACSIMILE: l� 4$0-0Gx3 TENTATIVE" APPOINTMENT DATE: 14L,/3/ -o1 Time: OSC-]D (Please allow 10 business days from date of application submittal - *Tentative only - must be confirmed) I?rCHECK BOX TO EXPEDITE REQ P1 15 F (CA OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS/DAYS SIGNATURE OF APPLICAN DATE Electronic Information: ❑ Listn Map - description: Specific Date Range of Information RequeW5,4From- to �0• PNVIkONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CL P,S11'F LOP) Ll HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE OTHER CLEANUP SITE (NaN-LO )' ; ❑ FOOD FACILITY ❑ WASTE TIRE I o n DERGROUND TANK (MONITOR[ EVAL) � ❑ Doc KENNEL [j DAIRY W' Q'IAIARDOUS MOWASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT I Z-/' fi ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM"L TOILETS ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERM[? RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDINo HOLIDAYS) 1. List up to ten address" In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to the address Indicates g¢g-m. Address ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after 2:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $116 deposit prior to review. 5. If you need further assistance, please contact Diane Martinez, at (209) 468-3426. .a„J 4-t3 I lam �Lij77L'��:,rJ.PL;ri.' C/_./■■ . • :r !t//�,/ ■ �t4lf�llrL� � `1 e/II � !/, 113'[%illlZiL�' LHO "-Ub ..I— FILE -ADDRESS EHD USE ONLY City upa' Street # Street Mama 2. 9b /fijo frTAh* 2 S �� (�.T U ?-I� 3. , Lo>z v 'Ttkcy G pz L t`� ,�n woe vu, 4. W l -i 5• Z`��-S 4�YD -TKa�c. �� ' �5, AVO co/y I 4- A 7. Unit 5 8. 9. a's:3 F I Unit B 10. Specific Date Range of Information RequeW5,4From- to �0• PNVIkONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CL P,S11'F LOP) Ll HOUSING ABATEMENT ❑ SOLID WASTE FACILITYNEHICLE OTHER CLEANUP SITE (NaN-LO )' ; ❑ FOOD FACILITY ❑ WASTE TIRE I o n DERGROUND TANK (MONITOR[ EVAL) � ❑ Doc KENNEL [j DAIRY W' Q'IAIARDOUS MOWASTE GENERATOR ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT I Z-/' fi ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM"L TOILETS ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERM[? RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDINo HOLIDAYS) 1. List up to ten address" In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0138 or mail to the address Indicates g¢g-m. Address ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received after 2:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $116 deposit prior to review. 5. If you need further assistance, please contact Diane Martinez, at (209) 468-3426. .a„J 4-t3 I lam �Lij77L'��:,rJ.PL;ri.' C/_./■■ . • :r !t//�,/ ■ �t4lf�llrL� � `1 e/II � !/, 113'[%illlZiL�' LHO "-Ub ..I—