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/14/2006 12:03 FAX 1 209 234 W STOCKTON 9 001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN doAQtmvCOUNTY CF <br /> �/y� <br /> ENVIRONMENTAL HEALTH DEPARTMENT `.II <br /> 304 East Weber Avenue, 3`3 Floor, Stockton, CA 99 -� <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.slgo . P�12: $$ <br /> $41, i)U Id C'011r4TY <br /> PUBLIC RECORDS RELEASE APPLICA#dip <br /> APPLICANT. �1 r'I BUSINESSIAGENCY: (.T 7 sSO�, <br /> ADDRESS: '�J"1ID 1j],,--LS4- H-AA44Xtiw'- Ln 4.1 I e_>4eF <br /> PHONE(1):(ZOq) 215k- PHONE 12): FACSIMILE: LZ(JA�Z�JN—�a-Z4 <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application Submittal-'renfaNve only-must be Confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> UNIT DISTRIBUTION ❑unit t ❑UnB 2 Unit 3 ^Unit4- ❑Unit 6 13 Unit 6 0 Other(electronlGlistslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name .p1 _ City <br /> 2. <br /> 4. <br /> 6. <br /> 6. <br /> r L — <br /> 9. - <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT O SOLID WASTE FA-:ILnYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) E3 FOOD FACILITY 0WASTE TIRE <br /> UNDERGROUND TANK(NOWTORINOIREMOVAL) ❑DOG KENNEL C1 DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 WASTEWATER TREATMENT PLAPR <br /> rI TIERED PERMITTED FACILITY 13MOTELA10TEL ❑PUMPER TRUCKIYAP.DICHEMTOILETs <br /> ❑TATTOCMOOY PIERCING G POOL/SPA ❑LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY CI OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMFT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY.FRIDAY 8:00 Am-5:00PM - EKCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file 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 files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <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 file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 4e-02Uee <br /> 1/UM6 <br />