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DAT N EHp LOG NUMBER <br /> SAN .10AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Ok <br /> 600 Last Main St, Stockton, CA 95202-3029 <br /> FN%I(Roracnl=� (209) 468-3420 Fax: (209) 464-0138 Web. www.sjgov.org/ehd <br /> P�flMnI,IS .�,�ICiSPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C'o 0001 .V.: BUSINESS/AGENCY: 5elw,;,ccs T t- _ <br /> ADDRESS: 3 `1: LI /'�,�cov; Flit �t�T�L CITY/STATEIZIP: �1�rclr.�nTo C—A 9SS'7-1 <br /> PHONE (1): 2/� LIVO- PHONE (2):� FACSIMILE: 14 17�0.0603 <br /> TENTATIVE"APPOINTMENT DATE: p calf iP 5L I~(t. Time:_ <br /> (Please allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ EST-$1 2 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information. ❑ List Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name City 1 <br /> Alu7 Unit 2 <br /> s, Jj <br /> � � � [ <br /> 4. DL�NO Y (w � c JC &,0 --7/0 _.LJ nit 3 7 <br /> 5. ' <br /> 6. _ .ALJ Unit 4 <br /> 7. <br /> ❑unit s <br /> �• I <br /> 10. <br /> 171 Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> KUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ASAIEMENT ❑SOLID WASTE FACILITY/VEHICLE <br /> fZ OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT I I-3 1( <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY/) <br /> WELL AND SEPTIC PERMIT RECORD$ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:00PM(ExCLUDING HOLIDAY$) <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall to the address Indicated 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 END will notify the applicant If any EHD flies 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 /> 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 file 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> D <br /> 3 3 <br /> P, CAL554 <br /> EHD 40.44 <br /> 07129/10 <br /> 100/L00[A )tdj Zl ll 1LOZ/bZ/Ol <br />