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SANU �~ s*DL0� <br /> FEBENVIRONMENTAL HEALTI <br /> 28 2013 1888 East Hazelton Avenue, Stockton, 95205-6232 <br /> 41 u � <br /> Telephone: (7Og) 4G8-342OFax: /JOgA484-0138Web: Vvvvvv jgoKoro/ehd �� <br /> EN14"R'QN!',,4EN7pLHVkLT.*-, <br /> � <br /> pBFN4I7/SEA%1140E="_; PUBLIC KC RECORDS RELEASE APPLICATION <br /> APPLICANT: 51A k_Hj,�,)IWDEK __ �Pfk_kp_ BUSINESSIAGENCY: <br /> PHONE (2): FACSIMILE: <br /> TENTAT/VE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only--must be confirmed)- <br /> SIACUIECK BOX TO EXPEDITE REQUEST---V25 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> N T RE OF APPLICANT DATE , <br /> Electronic Information: El List E] Map— Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> If TL C <br /> El Unit 2 <br /> 3. <br /> 4. <br /> 5. <br /> 11!77 <br /> 7. <br /> 8. <br /> El Unit 5 <br /> 9. <br /> 10. <br /> El Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,_�KUNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FACILITTIVEHICLE <br /> el <br /> L25QTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE h I" <br /> UNDERGROUND TANK(MONITORING/REMOVALY�_ El FOOD FACILITY DAIRY <br /> ABOVEGROUND TANK 16�3 <br /> 0 CHICKEN RANCHI DOG KENNEL WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY, POOL/SPA LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING COMPLAINT/RESPONSE RECORDS F1 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from7he list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 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 /> 3:00 pm will be processed the next business day. <br /> 2. The EHDwill notify the applicant ifany EHDfiles exist. Anappointment for review will beconfirmed approximately ten (10) <br /> days after receipt ufapplication. The files will boheld for emaximum uffive business days for review. Appointments <br /> should boscheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew application may bo <br /> submitted when the file imavailable. <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 />