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DATE RECEIVED END LOG NUMBER <br /> SAN .7rOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, Yd Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd7 <br /> � <br /> PUBLIC RECORDS RELEASE APPLICATION 1111(( rT <br /> APPLICANT: HBr BUSINESSIAGENCY: E71r finoYj7,1,4f? !{ <br /> ADDRESS: „Z, 95 Na/e.llo ! rositnP e .u 52 3 PHONE(l): J.75- (00,2 -'f F IC X41 PHONE(2): FACSIMILE: 5k.75-60.:7 -11F.26 <br /> TENTATIVE'APPOINTMENTDATE: r--.3 e7 Of Time: /O*ft <br /> (Please allow 10 business days from ata of ap icatiDn submittal•`Teniadve only-must be conflrmad) <br /> CHECK BOX TO EXPEDITE REQUEST�•/$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT rv( 2. L t fief' DATE VZ46& <br /> Electronic Information: © List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street C Street Name city ❑ Unit 1 <br /> �. <br /> SOS nt cdlartGY w I <br /> 2. r5%5 W ( rMv ❑ Unit2 <br /> 3• 440 IN rf& U (Yan�loYC <br /> 4. 41/ If Cary a ck.f /Oil <br /> 5- 414 W cA04>br A&V J700L^4 L- <br /> unle a <br /> 6. 14& 5' <br /> T. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> Unit 5 <br /> vd <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ✓�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 12YSOLID WASTE FACNJTYIVEHICLE <br /> .�{ <br /> yam+OTHER CLEANUP SITE(NOWLOP) O FOOD FACILITY O WASTE TIRE <br /> /6 UNDERGROUND TANK(MONrropmaIREMOVAL) O DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH O WA$TEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEIJHOYEL O PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOCIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> 17 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND Et"C PERMIT RECORDS ARE.AVAILABLE FOR REVIEW - MONDAY-FRIDAY 9:00 AMS:DOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addressor In the apace above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)46"138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 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 approximately ten(10) <br /> days after receipt of application. The flies will be held fora maximum of five business days for review. Appointments <br /> 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 application may be <br /> submitted when the Tile 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 applicant <br /> Future file reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EH04ami 1&2006 <br /> TO 39Vd Hd 9NI633NIDN3 DI13 0Z1tZ099ZGT 20:60 9002/ZT/ZT <br />