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1234 KLEINFELDER 1:22 12-03-2010 1 /1 <br /> Vn 1 C rNMICIV au 4 I�qI SAN EHD LOG NUMBER <br /> .1QAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> - PUBLIC RECORDS RELEASE APPLICATION _)(_C0d t� aMTsSe s <br /> PLICANT:�n� BUSINESS/AGENCY: <br /> VPRESS: ���� (�N�S CITY/STATE/ZIP: <br /> PHONE(1 __kA - PHONE(2): FACSIMILE: <br /> - TATIVE"APPOINTMENT DATE: Time. <br /> tv•' �R�((ISE (Please allow 10 business days from dat 'app' <br /> bmittal-'Tentative only-must be confirmed) <br /> P CHECK BOX TO EXPEDITE REQUEST-$122 FE C SH OR CH K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE '� Q(� <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS _ EHO USE ONLY <br /> Street# Street Name City <br /> - -- — n <br /> 2.- -�=` f o �-M�� � IAF -�� Unit 2 <br /> 3. - - <br /> �(JI <br /> 4 <br /> 4 nit 3 I L <br /> (A <br /> 6. 75W <br /> � .r)f�Unit 4 <br /> z. <br /> B. �.� <br /> 9 --- — ❑Unit 5 <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From h1L to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> r0_T=LEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ��,�[,�fN�OEERGROUND TANK(MONITORINGIREMOVAL)D(_ ❑DOG KENNEL ❑DAIRY <br /> [7J A RDOUS WASTE GENERATOR a- ❑CHICKEN RANCHn <br /> ❑TIERED PERMITTED FACILITY ❑WASTEWATER TREATMENT PLANT )Z_ 7-I V <br /> ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> -9EEDICAL WASTE FACILITY ❑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 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 /> 3:00 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$122 deposit prior to review. <br /> _ EHO USE ONLY <br /> A 107 6F <br /> a ;5'0 00 <br /> 1( <br /> 12 -ID Oh e r ndo I -(!7 pZ►Z51 <br /> EHD 4806 7a�lgl 7 53 7 �7t5 <br /> 07/29/10 <br />