Laserfiche WebLink
- - -- - ---- , ..vnV ulum LVUNTYI•,� "�F•,.I" 41`10LOG NUMBER <br /> I 1./ �N <br /> 1C)"ENTAL HEALTH DUARTNIrriT <br /> 304 EaST'WCbeT Avenue, V Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (204 464_ /� e <br /> 1, ) 0138 Wcb: wvwsjgov.orglehd z <br /> �W ,/) <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:-.��11DSC.QIM C,G <br /> ADDRESS: 11III I 1 LGN-g p� <br /> 109 _«�M_ Ay� -BUSINcSSIAGENCY:-41 ass <br /> PHONE(1): - "i- ti2'Li CIN E <br /> PHONE(2): STATE C-A <br /> _ <br /> TENTATIVE"APPOINTMENT DATE; ,Z'.Q l7 FACSIMILE: 261•S Cj•ZZZS <br /> (Please Slow 10 busimss days from date Of ePDIiCaGon subm lUal,•TTlma: , <br /> CHECK BOX TO EXPEDITE REQUEST- 4r.. <br /> enfa4va only-m uSt be connnnedl <br /> SIGNATURE OF APPLICANT ^ CY} 1c--rEE(CASH OR CHECK ONLY).REQUEST PROCESSED IN J BUStNE35 DAYS <br /> EkCtronic DATE "` _`� <br /> IMom+anon � l ht O ml .,p, <br /> -OesCriptior. <br /> stEe.e a FILE ADDRESS <br /> t. <br /> She"Hama EHD USE ONLY <br /> 2. ° C U cay <br /> 2 OS i; <br /> �• 2 2 <br /> 4. U Unit 7 <br /> 5. zt O Unit 2 <br /> 7. Z Unit 3 \1 <br /> B' as it 4 <br /> s. <br /> tD `� b9--. O Unit 5 <br /> SPecific Date Range of Information Requested: From �{ - J Unit 6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES���� AyG <br /> 0 OTHER CLEANUP Sire(NON.LOP) SRE(LOP) tJ <br /> HOUD FA AaAT¢NENT tJ SOLID WASTE FACRRYNENS;LE <br /> n UHDERCROUH TANK ASTEG GENERATOR <br /> d FOOD ENNEIY ❑WASTE Tei! <br /> •"FRED ER WASTEGENERATOR ) 0 DOG KE RA d DAIRY <br /> •TA"Vo ERMI P Ret CLITy 0 OHICKE OTIL WAST <br /> O TAT•OWBODY PIERCRIO 0 NOTEI,/HOTEL EWATER TREATMENT PLANT <br /> O PODLI$PA b PVMPER TRUCK1yARD(CHEMICAL TDI <br /> t7 MEDICAL WASTE FACILITY b LAND USE APPLICAl1ON SITES <br /> WELL AND SEPTIC PENAT RECORDS ARE AVIOLABLEFOR <br /> C3 OTMER(PLEA5E ONOA) <br /> 1, List Up t0 ten addresses In.the space above. Seloct(he yp6(s) fRrogy l:rom <br /> AM-s:eeplt - EXCI ugRO HDUD��—AYs, �- <br /> appropriate box(es). At least one file type MUST be selected. the toof e(2031 aGh 6138 ob ve bto the address <br /> Indicated above_ Address ranges will not be accepted-for additional assistance with fife add— rQsses,oontact <br /> fhe 0D. Applications received after 3:00 pm will be processed the Next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment to, review will be confirmed <br /> days for review. Aerg ppointments s days shouldreceipt <br /> be scheduled accordingly,tion. The will be held for a maximum of five business <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future the reviews by the same applicant may require a$93.00 deposit prior to review. <br /> — te r. �4V, L.= <br /> FMD 1101 �— <br /> ronlnaoe <br />