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JUN-14-2010 MON 04:56 PM FAX NO. P. Ol <br /> 17 (17 <br /> EHD LOG NUMBER. <br /> J .s�AIV �17ApUfN BOUNTY <br /> JUN 1 4 u',11 ENVIRONMENTAL HEALTH DEPARTMENT <br /> i 600 East Mail) St. Stockton, CA 95202-3029 <br /> ENone:(209)468-3420 Fax- 09 464-0138 Web: www.s ov-or /eh <br /> PE'VIAMS-`�`��' � PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: fKQ re.n Tk roBUSINESS/AGENCY:De.. c.er AA ' C' <br /> f= <br /> ADDRESS' 50 remanj 54' 20"Fl.- _ � CITY/STATE/ZIP: an.P!'o I i co C t o 5 <br /> PHONE(1),k5l59I - 572 PHONE (2):_(j(IS) 5j J-w7SOQ FACSIMILE:(WS)S9/- 7S 10 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from data ofof apidication submittal-*Tentatiye,only-must be confirmed) <br /> O CHECK BOX TO EXPEDITEREQUE T-$115 F F(CASs I OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT• DATE <br /> Electronlc Information: ❑ List❑ Map-Desel•iptloti: <br /> _ _FILE ADDRESS EHD USE ONLY <br /> Street#E Street Name _- City Unit 1 <br /> 2. _ nft 2 <br /> 3. <br /> _ nit 3 <br /> 4 <br /> 5. ri IM <br /> - nit 4 <br /> 6. <br /> NMI- <br /> 0 <br /> ❑Unit 6 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range.*f Information Requested: From Qf C / to d r•eS'.M4 <br /> ENVIRONMEN'rAL HE.AI.TH DEPAR MENT FILES SOLID WASTE FACILITYNEiHICLE <br /> -0UNDERGROUNDTANK(UST)CLEANUP SITE(LOP). HOUSING ABATEMENT ❑WASTE TIRE <br /> ;OTHER CLEANUP SITE(NON•LOP) [i F00o F ACILITIf DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ['I DOG KI NNEL <br /> HAZARDOUS WASTE GENERATOR [:I CHICKEN RANCH ❑WASTEWATERTREATMENT PLANT <br /> PUMPER TRUCK/YARD/CHEMICAL.TOILETS <br /> ❑TIERED PERMITTED FACILITY C I MoTetJHOTEL ❑LANs)USE APPLICATION SITES <br /> TATTOO/BODY PIERCING [I POOLISPA ❑ �Pi +n et M <br /> ❑ MEDICAL WASTE FACILITY r I OTHER(PLEASE SPECIFY) Q I S o 4 I 100 11 PQ rrn(f S Snd <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE:FOR RIEVIEW: MONDAY-FRIDAY 8:00 AM-6,00PM(EXCLUDING HOLIDAY <br /> 1,,ggsmi= <br /> n addresses in the space above. SeIE ct the types)of files from the o t above es checking the appropriate <br /> t least one file type MUST be selected. F;�,�;t 209 464-01 o ail to thea ss indica ove. Address <br /> not be accepted-for addltlonal assist:+nee with file addresses,contact the'EHD. Applications received after <br /> ll ba processed the next business day, roximatel ten 102. ill notify the applicant if any EHD files+exist. An appointment for review will be confirmed apP ointments ( ,receipt of application. The files will be held for a maximum of five business days for.revlew. App <br /> should be scheduled accordingly. � <br /> 3. A file that is actively being worked on by EHD stat i�iYsbe t �, table for review. Anew apptication may he <br /> e file Is available. R <br /> submitted when the of the applicant. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense p <br /> Future file reviews by the same applicant may require a$116 deposit prior to review. <br /> 5. If you need further assistance,please contact plane Martinez,at(208)468-342b. <br /> EFID USE ONLY . <br /> 8127!99 <br /> Mp 4"S <br />