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4, vYV10 Ic.oD FMA _ 10002/002 <br /> 6/LKt `7 r 013. ENVIRONMENTAL K H rf� ui <br /> 11/1 EHD LOG NUM6ER <br /> SAN JOAQUxIV COUNTY <br /> �s 0 4 2006 U'NVIRONMF,NTAL MALTH DrPARTmENT <br /> 304 Past Weber Avenue, 3`d Floor, Stockton, CA 95202-27( / Q <br /> C r� �u{ R{1 IENT H%i4hone:(209)468-3420 Fax: (209)464-0138 Web:www,tgov.org ehd <br /> L PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ fil 5 r � ;�)I,- .y- 9IU61NE=AGCNrY: <br /> APDRES5: A F,;�S /�� MfP-7/G <br /> PHONE(1): ;:bl ..9Hg_1 '34 S PHONE(2): FACSIMILE: 9`7 8-06 P- '- <br /> TENTATIVE"APPOINTMENT DATE: nme: <br /> (Please snow 10 business days from date of application submittal•'Tenfabw only•must be malim ed) <br /> C7 CHECK BOX Tu FXPrDITE REQUEST-SSs.00 FEE(CASH DR CHECK ONLY)-REOUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Ereetronic Information: ❑ List❑Map—Description- <br /> FILE ADDRESS LHD USE ONLY <br /> Strout street Name city - ❑ Ur It 1 <br /> ?S60 m s o4 d Jc <br /> 2. 4eUntt2 <br /> 3. <br /> 4. Unit 3 / <br /> B I�Unit4 <br /> 14 <br /> 7. <br /> 171 ums <br /> s. <br /> 8' urate s <br /> 1 U. <br /> Speclflc Data Range of Information Requested:From to <br /> q , ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Do UNIIERGROUNb TANK(UST)CLEANUP SrrE(LOP) ❑ Hatsm AsATSAIENT KSoul)WAsm FACsMNEtaCLe <br /> Pill,OMERR CLEANUP SITE(NOH-Lop) O FOOD FAcem ❑WASTE Thu <br /> Q UNozRcAwi in TANK(MoMrofaNWRENcvAL) ❑Doo KkNum DAIRY <br /> pk HAr7ArRDous WASTl GENERATOR Wciec"H RANCH WASTEWATER TREATNE1rr PLAW' <br /> ❑ TWtM POU4"ED FAC116" 0MoTiLhb7m ../�, PUWER TRucriTAx IcH171a Tongs <br /> b TATTODMI00r PILKING Q PQQLiSPA y(1 LAND Uss AAPLICAmOH&TES <br /> P MEDICAL WA FAOILRY ❑chER(PLEAsa SPECIFY) <br /> WEU.AND SEPTIC PE w RgcceD2 ARE AYAnAeLE FOR REy rw- MONDAY-FRIoAT 0:00 AM-S:OOPY - ExCLVom HOLIDA". <br /> 1. U■t up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es), At least one file type MUST be selected. Fax to(209)49"138 or mail to the address Indicated above Address <br /> ranges will not be aecepted-for additional assistance with file addraases,contact the EHD.Applications received atter <br /> 5:00 pm will be processed the next business day. <br /> 2. The EHD will notlfythe applicant If any EHD files a4sL An appointment for review will be confirmed approximately tan(10) <br /> days after receipt of application, The files velli be held for a 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 bo immediato(y available for review. A new application may be <br /> submitted when the file is avallable. � <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 /> HD Gens 9i oos <br />