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Y ��c 5106559517 7-954 P.02/05 F-713 <br /> ,AN JOA � J <br /> �5� QUIN COUNTY <br /> &VIRONMIENTAL HEALTH DEPARTMENT <br /> JUN 0 5 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sj ov.p /e <br /> 0*7 <br /> ENVI>"IJNkIEN 1 !�Er't!_i}i <br /> PEPif i 2 E R V I c E" PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �i1�cV �•�� ,}{ � f SUSINEWAGENCY: V <br /> ADDRESS: lakU L L7 ST M�10U,.FMEPV til <br /> PHONE(1):C IO)4-2-o"25Q-S PHONE(2): ./ (• CP O <br /> FA SIMILE <br /> TENTATIVE*APPOINTMENT DATE:All01109 Time: <br /> (Please allow ten business days from date of appReatton submittal-'Tentat/ve only-must be conflrmed) ' <br /> r3 CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH Oft CHECK ONLY)-REQUEST PROCESSED IN THREE RUSIN S DAvs <br /> SIGNATURE OF APPLICANT .Gdil f`{ kCjbla AeA7t�+ DATE �1 <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS <br /> Street S END USE ONLY <br /> Street Name <br /> C <br /> 1. '�s o ity /In <br /> k 1 <br /> 2. O <br /> 3. d nit <br /> 4. <br /> S. '� - � )"rVAit 3 <br /> 7. R4 <br /> 8. <br /> 3 <br /> g- <br /> nits <br /> 10. 1 601niVq PWyk(.Vituvt S vt#_t <br /> Unit ti <br /> Specific Date Range of Information Requested:From <br /> l , <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UIWERGROUNO TANK(UST)CLEANUP Erre(LOP) HOUSING ABATEMENT <br /> O HUR CLEANUP SITE(NoN-LOP) FOOD FACILITY Souo WAsW FAcv"fV8HICLE <br /> UNOE�OUND TANK(MON"*RINWReMOVAL) DOG KENNEL WASTE TIRE <br /> HAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH WDAIRY <br /> TARED PERMITTED FACILITY �WASTEWATER TREATMENT PLANT <br /> ❑TATTpp/gapY PIERCING MOTEUHOTEL PUMPERTRucK/YARD/CWA TOILETS <br /> C3 MEDICAL WASTE FAcu nYPOOL/SPA LAND USE APPLICATION SITES <br /> L7 OTHER(PLEASE SPECIFY) <br /> WML ANO SEPTIC PURMrr RECORDS ARe AVAILABLE FOR REVIEW-MONDAY-�FRr0AY 8:00 AM-S:OOPM - EXCWDwG HOUDAYS. <br /> t. List up to ten addresses In the space above. Select the type($)of fetes from the list above by checking theappropriate <br /> bo 0s). At least one file type MUST be veelected. 05 r lI o <br /> riot be saePWd-for additional assistance with file addresses,contact the EHq. Applications reaeiz. Address <br /> after S.00 ng will <br /> be Processed the next business day. <br /> ill <br /> Z. The EHp will notify the applicant If an END files exist. An a <br /> y PPointnR for review will be aonflrtnsd a <br /> days after receipt of application. The tiles will be held for a maximum of five business days for revievvpproximately ten <br /> should be scheduled accordingly. Appointment$ <br /> 3. A file that is actively being worked on by the EMD staff may not he immediately available for review. A new application <br /> 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 tfte expense of the applicant. <br /> Future file reviews by the some applicant may require a$98.00 deposit prior to review. <br /> END USE ONLY <br /> Tom <br /> PUBM RE RELEASE APP FORM <br />