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DAhl RECEIVED � EHD LOG NUMBER <br /> R <br /> - �� IVESAN .�aA4uINCauNTv <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> I:IiAR 2 3 Z011 600 East Main St, Stockton, CA 95202-3029 <br /> Telephone: (209)469-3420 Falx: (209)464-0136 Web: www.sigov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLPCANT:_..., J ...�` IS/Ip/ ',r, ,BUSINESSIAGENCY:_-. z- <br /> ADDRESS: --,- _-..........._,�' 1�.�7(_'�L,'nl p>�r-�ri .L,rd iTfsZ�CITYtSTATErZIP: � "'--i1.1t V� <br /> ._�_.� ,J?,-' SAT <br /> PHONE.($]: /^ PHOWE(2]: FAC319NILE: � <br /> TENVTAT VV 'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from"daof aPfcatlon submhtal —Tsaodvonly-must be coMmedY <br /> --- <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$195 FEE(C. S i CHEC N REOUPST PROCESSED IN 3 13USINESS DAYS <br /> SIGNATURE OF APPLICANT rr� DATE <br /> Electronle Information: ❑ List❑Map—Oaecripeion: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street a Street Name CIy r, /' <br /> .. -7 FI las 'I3(- Oil )<UnRt <br /> 2. '1. °syr r`d�r1 .ZL77/�//��Ili1 CYI 1�cd, [(� / Sfr�kfrn� 4sa� 3��i�,( � /// YYY <br /> J/f�/:na'e+rL ..7�'TV � lerz ! I ;F 1 � �fi�'A. (j Unit 2 <br /> 9' I kP-44s/6r' Z 2 t3 W. / 4 c� Lly e 93 TO <br /> .. ( , s Q 1F.361 LA). <br /> 8RNgo-Rd <br /> T5.. 34 r lerr H Yr 591 <br /> v /Stl�!"����l�/C'�g5 ..F7IY!Tt'�eC#dlF+1 K' / 3 .._ , <br /> �1 <br /> ,4(4&1!w tdA <br /> 'Pled { r S-43fNNe.Si, <br /> 18. <br /> q unit a <br /> 1 D. <br /> Unit 8 <br /> Specific Data Range of Infonsstion Raqueated: From to <br /> ENVIRONMENTAL-HEALTH DEPARTMENT Mors <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSIN43 ABATEMENT <br /> ❑OTHER CLEANUP SITE(Non-LOP) W FOOD Fmtun-JN,; Aydr' k r- r©'T QLD WASTE PACILIIYNEfUCLE <br /> ❑ WASTE Toiz <br /> UNDERGROUND TANK(MONITORtNG1REFARAMOVAL) ❑DOG KENNEL DAVIY <br /> ` I-.+ <br /> ❑HAOOu'S WASTE GENERATOR Ll DAVIY <br /> IJ CHPCKF:N RANCH ❑WASTEWATER TREATMf>:NT RANT <br /> ❑TIERED PERIN TTED FACILITY ❑M01 FA.lHO'rEl <br /> [_I TATTOOIBODY PIERCIV40 ❑P(roUSPA ❑LANPLNDER E ATRiPPUYARDON SITES TOILETS <br /> ❑ MEDICAL.WASTE FACILITY ❑OTHER(PLEASE SPECIFY) ❑I-'aND USE APPLICATION SITES <br /> ....._.._C ._.._. 0_0 AM-6:00Prr(EXCLuoiNGHOLIDAYS) <br /> WELL AND SEPTIC;PERMIT RECORDS ARF.AVAILABLE FOR REVIEW; MONDAY-FRIDAY S; <br /> t ...4.1s1 auto den dreassf,-g2 In the space above. Select the types)of fNss from the list nbavo by checking the appropriate <br /> box(es), At least one filo type MUST be selected. EUto(2091 484-01 3 8 Or mmall,�,L}vo ad ess indicate¢ab0Ye. Address <br /> nnges will not be accepted-for additional assistance With file addressee,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD wilt notify the applicant if any EHD files exist. An appointment for review will be confirmed)approximately ten 110) <br /> days after receipt of application. The files will behold fora 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 to released will be reorganized by EHD staff at the expense.of the applicant <br /> Future file reviews by the same applicant.may require a 9116 depoen prior to review. <br /> 5. If you need further assistance,pl0a$a contact Diane Martinez,at(209)468-3426. <br />