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05/10/2008 09:54 91644F"-93 MATT PAGE 01 DATER CEIVED EHp LOG NUMBER SAN .10AQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT �! r- 600 East Main Street Stockton, CA 95202-3029 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/e d CPUBLIC RECORDS RELEASE APPLICATION C , APPLICANT: p� S/�?At~�t Y BUSINESSIAGENCY: DEL-T)q AIf TQ ADDRESS: -22_LE U 4/-4- 3-0 GJ r9 f 5 c 2 h^'!Fa✓h7 Gro �j eld PHONE(1): q 16 4g-L 3e03, PHONE(z): FACSIMILE: TENTATIVE`APPOINTMENT DATE: 5-_Zq—ott Time: '1 30 R-1 (Please allow ten business days from date of appucatlon submittal--Tentative only-must ba confirmed)- CHECK onfirmed)CHECK BOX TO EXPEDITE REQUE�Wng_ 0�FEEH OR CHECK ONLY).REQUEST PROCESSED IN THREE BUSINESS DAYS SIGNATURE OF APPLICANT DATE Electronic Information: ❑ List❑Map-Description: FILE ADDRESS _ _ EHD USE ONLY Street 0 Street Name Clty ©Unit 1 z. I IbC� --- W. YUS_ ►r� 0qvF�uC M4N�C_.,� vihyi:t t t�;(� gip. ❑unhs 3. I 13 Cn'ler�Z wf y'' STCJC�74� 4. ( (.v-4 ir4 L dp /�c?9 L7 5 Zl C k i 4+�1 ,0 6^'.J',,vo �;4flcffall s .. _ � � X= 6. 264d t uy � unit a Z(r? 7 4�421?�rJ WFjY �i� a �M. )065,i q9 /l�d�f/iq ❑units J 1 &A), f 10. ❑Unit 6 Specific pate Range of Information Requested:From to .0 P2s�5Eryr �,� ENVIRONMENTAL HEALTH DEPARTMENT FILES p I ( r 1 UNDERGROUND TANK(U$T)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT M SOLID WASTE FACILITY/VEHICLE OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE , ^_ .t�LINDERGROUN4 TANK(MONITORING/RE MOVAL) ❑DOG FENNEL ❑DAIRY V I'�I -KHAZAROOU9 WASTE GENERATOR M CHICKEN RANCH Q WASTEWATER TREATMENT PL NT TIERED PERMITTED FACILITY ❑MOTEUNOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS TATTOOIBODY PIERCING 0 POOLISPA ❑LAND USE APPLICATION ITES n E3MEDICAL WASTE FACILITY ©OTHER(PLEASE SPECIFY)�� / V-4'q p T i y( 7 r E WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW -MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS. 1. List up to ten addresses in the space above. Select the type(s)of flies from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the above address. Address ranges will not be accepted-for additional assistance 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 days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by the 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$98.00 deposit prior to review. EHD USE ONLY l - 61 - it S'f EHD 49-06 I W"1p7 PUBLIC RECORDS RELEASE APP FORM