Laserfiche WebLink
11 <br /> Li �Lu ­'iaiuiVTX <br /> �` t"U LOG NUMBER <br /> i EN tONMENTAL HEALIff DEPARTMtr!r <br /> 304 EasMOber Avenue, 3"1 Floor,Stockton, CA 95202-2708 <br /> Telephonc:(209)468-3420 Fax: 209 464. /1/1 <br /> ( ) 013$Web: wvnysjg0V.0rg%ehd Z 3W <br /> PUBLIC <br /> APPLICANT: RECORDS RELEASE APPLICATION <br /> _�V`� QI" �,_ <br /> ADDRESS:_I I LONE P 6USINcSS7AGENCY; <br /> PHONE(Jj �,Fa: 2vv' V� ---.�-�aTr E A SSOGI' pia <br /> PHONE(2).. STATE <br /> TENTATIVE`APPOINTMENT DATE: KACSIMILE: 2 O'1•S cj•Z s <br /> (Please aaow to business da '21'Qb <br /> YS from date of application SUbMltull.• Tlma:—�i� qr„ <br /> lJ CHECK @Ox TO EXPEDITE REQUEST- rtttlaave�^IY-mus!be conRrmed) <br /> SIGNATURE OF APPLICANT ffJ.pO FEE(CASH tM CHECK ONLY),REQUEST PROCESSED IN 7 9U51HESg DAYS <br /> Ekct'°ruc „DATE <br /> IMpml� apo oy_ ❑ List O Map-DeScriptipn O <br /> street a FILE ADDRESS <br /> C U <br /> Street Name city EHD USE ONLY <br /> � U <br /> 2• 2 OS _ <br /> 3. 2 7, r <br /> 4. ❑ Unit 1 <br /> 5. 21 ❑ Unit 2 <br /> i. 'i Unit 3 a\1 <br /> �Gnit 4 <br /> 7tl' ❑ Unit 5 <br /> SPeCifIC Date Range of Information R to ED Unit 6 <br /> equested: From _ Pg5-r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES A'4 All A&_ <br /> '11�IUNDERGROUNO TANK(UST)CLEANUPSRE(LOP) ❑ <br /> OOTHERGUFANVPSITE(NON-LOP) HOUSINGAAATEMEXT ❑SOUS WASTE PAOILITYryEMICLE <br /> �C UN��D�E�RCROUNO TANK(MONITORIHg/RtMMAL G FOOD FACRnY <br /> Hd WASTE TetF <br /> /— ALAROOUS WASTE GENERATOR ) ❑ Doc KENNEL. IJ DAIRY TIERED PERMITTED FACLIry ❑CHICKEN RANCH C3 WAST <br /> TATTOOMODY PIEROINO C)MOTEUHOTEL EWATER TREATMENT PLART <br /> ❑MEDICAL WASTE FACILITY C)POOLISPA ❑PUMPER TRUCKNARo(CI EMICAL TOILETS <br /> ❑OTNER(PLEASE SPECiY) b LAND USE APPLIOklION sings <br /> WELL AND SEPTIC FEIUMT RFCOROS ARE.AVAUSLE FOR REVIEW -MONDAY FRMAY 8:00 AM-S;ooPM - EXCUUDINO HOLIDAYS. <br /> t. List up to ten addresses in the space above. Select the types) or files from the list above by checking the <br /> appropriate box(es). At least One Ole type MUST be selected. Fax to12091 a64�0139 or mall to the dress <br /> Indicated Ove_ Address ranges will not be accepted—for addi�'tlonal asslstanc'e wlHl fife addresses, contact <br /> the EHD, Applications received after 3:00 pm will be processed the next business day, <br /> 2. The EHD will notify the applicant if any EHD Oles exist. An appointment fes review will be confirmed <br /> dayformreview. Appointments s should be scheduuled accordingly,lication, The IAli be held for a maximum of five business <br /> 3. A file that is actively being worked on by END staff may not be Immediately available for revi <br /> application may be submitted when the Ole is available. ew, A new <br /> 4. Any file not returned in the came condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future Ole reviews by the same applicant may require a$93.00 deposit prior to review. <br /> l ..y <br /> 11T1 ,r,. <br /> EMouM <br /> rasv:xe <br />