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03/02/2011 12:05 FAX 1001/UDI <br />RECE /r D — � EHD LOG NUMBER <br />Lh.IV_�f C SAN TAL HEN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />MAR 0 2 2011 600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />pCRP�ITICFR\/ICER <br />I'M <br />APPLICANT: t tW� BUSINESS/AGENCY: <br />ADDRESS: '3 (I k4c . CITY/STATE/Z)P: tl- . g5$21 <br />PHONE (1): 416 o -OZ'i. PHONE (2): (Q16 IQ-Z2I2 FACSIMILE: Cef(L )I q8P—C3((3 7 <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal -"Tentative only - must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUES -$122 FEI ASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE --i 24-z.e <br />Electronic Information- ❑ List ❑ Map — Description: <br />LIMM, <br />1:%PA <br />MAE <br />FILE ADDRESS <br />EHD USE ONLY <br />❑ Unit 7 <br />Street s <br />Street Name <br />city <br />SAtk(,0%r4e7Tt L044c- <br />S-Ttx4-T0I-4 <br />6cJ <br />Units <br />3- <br />?A 00 <br />Cl4A(7-V'il(WM t -M6 <br />yrer-is—iar`{ <br />> i Z , -5/r U <br />Unna <br />4• Z L_t b <br />S'iSW0c4-T S <br />%TrzkTVr4 <br />5. <br />rit.-I?- <br />%T(»l- <br />Steak --m <br />unh4 <br />❑ Unit e <br />6. <br />T. <br />8. <br />�..._— <br />9. <br />❑ Unit 6 <br />10. <br />0 <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILE$ f � / <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) E] HOUSING ABATEMENT ❑ SOLID WASTE FACBfTYNEHICLE -7b''cn6 k <br />OTHER CLEANUP SHE (NON -LOP) ❑ FOOD FACILITY ❑ WASTE TIRE , I ^ 1 2 <br />pq1) UNDERGROUND TANK(MONRORINGIREMOVAL'V\ [3 DOG KENNEL C3 DAIRY Ckr 7 J II <br />Ly HALIRDOUS WASTE GENERATORp� \ ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT � 3. -4 <br />TIERED PERMrTTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />3 TATt00/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br />MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONbAY-PRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />1. List UD to ten addresses in the apace above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax to (209) 464-0136 or mall to the address indicated above. Address <br />ranges will not be accepted - for additional assistance with file addresses, contact the EHD. Applications received attar <br />3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed approximately ton (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 />MW <br />LIMM, <br />1:%PA <br />MAE <br />ENP awe <br />