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•. Nov. 5. 2008 10:34AM Ad-anced Geolinvi ronfrental No, 3530 P. 1 <br /> DATE KCI.CIVt:uEHD LOG NUMBER <br /> SAN.TOAQI71N COUNTY <br /> WIRONIV ENTAL HEALTH DEPARTMENT - ( l <br /> �5All <br /> 600 East Main Street, Stockton, CA 95202-3029 "I `I/ <br /> Telephone: (209) 468-3420 Fax:,(209)464-0138 Web: www.sj;ov.org/eild <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> A�P1 _ lI r CoIAVI�a- _BUSINESSIAGENCY; rUax+lad (h�aEnvi")1Wjl <br /> o A S: �3 S110,11-1 Road $fiDcLto h 5 y(S 7 <br /> =p LN^PH;_W&);2,f)g"q(i F—da0lo _ PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE' Time: <br /> e allow 10 business days fr7�mbbdate of application submittal-"Tentative only-must be confirmed) <br /> Z CHECK BOX T EXPEDITE REQUE •$9EVO�EE( OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIt3iNA APPLICANT DATE Il'q-? <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS _ — EHD USE ONLY <br /> Street p Street Name I City n ❑ Unit 1 <br /> X54. 9ipc��on <br /> 0011 1,11 W�7 <br /> 2' I$r20 1R(d tG�XP ��Y(���OSdU. ti0 ItIDCCf1/h� C7 Unit2 <br /> 22(9U0(d-4,1�Olb/'�WP A) Unh9 <br /> 4. r _ _ <br /> oe <br /> 5. # + o�tl, r�nred_ Tl `a, m�lni Unita <br /> 6. <br /> A I ' El Units <br /> 6, <br /> 10. VI R <br /> s LW <br /> Specific Date Range of Information Requested: From to r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES FI(yJ�ttlSl�� <br /> O/UNOERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUsINC ABATEMENT O SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) 0FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONrtORINGIREMOVAL) 13 DOG KENNEL 0 DAIRY <br /> P HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY In MOTEUHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOIBoDY PIERCING ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAYS, <br /> 1. List up to ten addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 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 EHD will notify the applicant if any EHD files 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$98.00 deposit prior to review, <br /> ' EHD USE ONLY <br /> it50&' u2jil of (TIpw'.� UrfaE Jt f0✓ <br /> II &'w F iso - r 17 59 ;viro <br /> EHD 48-05 WEB 8182007 <br />