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e, AUG -26-2009 11:,10 From: To:1209%40138 PaGe:1,'1 DATE RECEIVED 171,10 LOG NUMBER SAN .10A(;�UIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main St, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd PUBLIC RECORDS RELEASE APPLICATION f&ADDAPPLICANT: k BUSINESSIAGENCY: by—LV ise- RESS: CITY/STATEZIP: Q{' *CAD PHONE (1): - PHONE (2):��0 �iLZ- Q � FACSIMILE: (9-W)q7 TE TAIIVE" APP01N MENT DATE: tpk 2011 Tlme: 1p ,q�✓j (Please allow 10 business days from datoo oapplication submittal -'Tentative only - must be confirmad) ❑ CHECK DOX TO EXPEDITE REST - $1,�5 • (CA I I OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT t/(e;6 A, DATE X123/11 Electronic Information: ❑ List ❑ Map — Description: FILE ADDRESS EHD USE: ONLY Unit 1 ❑ HOUSING ABATEMENT Street if Street Namo NDERGROUND TANK (MON ITORINGIREMOVAL) � NAZARDOVSWAsTr ❑ DOG KENNEL GENERATOR ve, 'city- ` �ttiV"`{�ll`� 2j D 5 /V nit2 `Z ❑ POOLISPA ❑ MEDICAL WASTE FACILITY 3. Unit 3 4' ❑ Unit 4 6. 7. 10. ❑ unit] Specific Date Range of Information Roquostod: From ENVIRONMENTAL HEALTH DEPARTMENT FILETS ❑ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY NDERGROUND TANK (MON ITORINGIREMOVAL) � NAZARDOVSWAsTr ❑ DOG KENNEL GENERATOR ❑ CHICKEN RANCH ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ MEDICAL WASTE FACILITY ❑ COMPLAINT RECORDS to l3� 2 (Q5 f0r ❑ SOLID WASTE FACILITYNEHICLE J ❑ WASTE TIRE ❑ DAIRY l _ ❑ WASTEWATER TREATMENT PLANT I V \ ❑ PUMPER TRUCKNARDICHEMICAL TOILETS ❑ LAND USE APPLICATION SITES [] OTHER (PLEASE SPECIFY) WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00pm (EXCLUDING HOLIDAYS) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax _to -(2091-464 0138 or mall to the address indicated above. Address ranges will not be accepted - for additional assistanos with file addresses, contact the EHD. Applications received after 3:00 pm will be processed the next business day. 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. S. A file that Is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $125 deposit prior to review.