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DA'L'E RECEIVED <br /> SAN JOAQUIN COUNTY EMD LOG NUMBER <br /> f �NVMRQNMENTAL, HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 W6b. WWII.q- 6 PUBLIC RECORDS RELEASE APPLICATIO ' <br /> APPLICANT: C FAy �J <br /> AbDRESS: SIT) Ivpt�l, W,LIk, SUSINESSIAGENCY: ormoo _ <br /> PHONE(t): - t7CityrStaterxip ' =3) <br /> PHONE(2): 'ZO � L( _ <br /> (� FACSIMILE: FRIP <br /> TENTATIVE`APP61NTMENT DATE. -OR <br /> (AlI allow 10 business days from dela o applicatlan submittal-'lentaliva only must be Confirmed) <br /> © CHECK SOX TO EXPEDITE RE4UE 05 F A R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE fdd-- <br /> Electronic Information: © List[J Map—Description: ;t <br /> FILE ADDRESS EHD USE ONLY <br /> Strom of Stroat Name <br /> j. <br /> (,[ /7 City 0'4 L 0-Cl IiI - e{ r, I <br /> ❑ Unit 1 <br /> 2. In 1�+n �' . Jra (� Unite <br /> 4. Unita <br /> 6. <br /> $. is ❑ Unit 5+ <br /> I. <br /> 9. <br /> 10 ❑ Unit G <br /> Specific Date Flange of Information Requested:From to f,L) <br /> ENVIRONMENTAL HEAL-rH DEPARTMENT FILES <br /> )4-UNDERGROUN1I TANK(UST)CLEANUP SITE(LOP) ❑HousING ABATEMENT C3 SOLID WASTE FAcILFY1VEHICLE <br /> MOTHER CLEANUP STYE(Nom-LOP) ❑Fo4D FAQILnY 0 WASTe TIRE <br /> Of UNOrk6i'MUND TANK(M4MTORINGIREMOVAL) ❑Dao KENNEL 0 DAIRY. <br /> WHAZARDOUS WA01E GENERATOR ID CHICKEN RANCH ❑WAgTI WATER TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY ❑MOTEVHOTEL ❑PUMPER TRUCKfyARDICHI:M TOILETS <br /> TAYTo01BoDY PIERCING ❑POOLISP0. .', ❑LAND Use APPLICATION SITES <br /> f ❑MEDICAL WAfi'rE FAGIuTY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR Review - MONDAY-FRIDAY 8:00 Am-5:a{IPM • EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above, Select the type(s)of fifes from the list above by Checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:08 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for reviyw 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. Ij <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A now 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> h <br />` END 4Q-06 8/04108 PUBLIC RECORDS RELEASE APP FARM <br /> Z0 -�9dd NOdIaMBN]l 56LT66560Z IV:TT 800E/LT/ZT I <br />