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02/16/2008 16:05 FAX lj�002/002 <br /> DATE RECEIVED SAN TQAQM COUMT EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3"Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)46"138 Web:www.sjgov.orglehd� <br /> 266 FEB 16 PH 4PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIC'/II$'t,� J�16 }-�, iT.". -- �+-� BUSINESSIIAAG-ENCY: �Lf_=In1�-� <br /> ADDRIJ§S:nL 'C.D"!.\ IE M�1 `?1 CITY C'r_E%N\ STATE ° f <br /> PHONE(1k Z.5 q%trf=13 YS- PHONE(2): FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE:_ _ I O �3 IO(o Time: <br /> 1 (Please allow 10 business days from datsal application submlKal-•Tenrdfim only-must be oonfirmad) <br /> U0 CHECK BOX TO EXPEDITE REQU T•$93.00,FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ZZ I L & G <br /> Elsctrvek ❑ List 1: M <br /> Information aP-rysscTlptlOR <br /> FILE ADDRESS EHD USE ONLY <br /> Slnst t: Street Name city <br /> 1' <br /> 2. El Unit 1 <br /> 9 <br /> 3' S <br /> 4. �Ufllt 2 3� / <br /> �' <br /> . <br /> 6. z /Unit 3 -2/Z z <br /> 6 <br /> T. - Unit 4 <br /> 9.. El Unit 5 <br /> 9 <br /> 10. e�r17 Unit <br /> Specific Date Range Of Information Requested: From P'A '+. a to <br /> ENVIRONMENTAL H At0H ARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ADATEMENT 0 SOLID WASTE FACILITY ' .l l <br /> P OTHER CLEANUP SITE(NDN-LOP) ❑ FOOD FACILITY Cl WASTE TrZ <br /> AUNDERGROUND TANK(MONmORINGIREMOVAL) ❑ DOG KENNEL )SI DART <br /> - HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH tQ WASTEWATER TREATMExT PUNT <br /> O TIERED PEANDITED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS ' <br /> ❑TATTOOISCOT PERCING ❑POOKJSPA ❑LAND USE APPLICATION SRES <br /> ❑MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELLANDSEM PERMm RECORDS ARE AVAnAaLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM-B:DDPM - EXCLUDING 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(east 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 flies 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 /> ENP 47-or <br /> 70171/2006 <br />