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EN ''ONMENTAL HEALTH DEPART <br /> ""J East Main St. Stockton, CA 9520 <br /> 1' ,I.,, ,,;,��►;- - hone: (209) 468-3420 Fax: (209)464-0138 We .sjgov.org/e <br /> I��, hd <br /> f`L <br /> 1✓CFtz1;� �!I �S PUBLIC RECORDS RELEASE APPLICATION <br /> in <br /> APPLICANT: 1'l .-T{-� (� BUSINESS/AGENCY: Z c— ' "n 1 <br /> ADDRESS: -L PA. . a{ C,ZCO CITY/STATE/ZIP: C.O5fk Me3aC kCJ'L(j2 <br /> PHONE(1): 5 Q- LP PHONE( :rJ- 1 O-&'95-G 2 FACSIMILE: '510-Z9-5- 2-(,#5 F <br /> TENTATIVE"APPOINTMENT DJSJ2 2 b 0 Time: YY� <br /> (Please allow 10 business days from date of app on su i- Tenfettve only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQ T-$115 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSt ESS DAYS <br /> SIGNATURE OF APPLICA DAA ZS /0 <br /> Electronic Information: 3 List amap- ription: oil <br /> FILE ADDRESS t� EHD USE ONIL <br /> Street# Street Name <br /> CTty ` <br /> 1. 2-I) l CS t h Unit 1 <br /> 2. - Unit 2 <br /> 3. <br /> 4. '3 = r i Unit 3 k \ <br /> 6. <br /> 7. 15V f }_ a Unit 4 <br /> r <br /> ❑unit 5 <br /> 3 <br /> 9- <br /> 10. <br /> Unit 8 <br /> Specific Data Range of Information Requested: From to 1K-13 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACIUTYNEHICLE <br /> ER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> %VNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ralWARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKMARDICHEMICAL TOILETS <br /> ❑TAT-roommy PIERCING ❑P00L fSPA <br /> El MEDICAL WASTE FACILITY El LAND USE APPLICATION SITES <br /> ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1- List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax (209)464-0138 or mall to the addne$s 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 END will notify the applicant If any EHD files exist An appointment for review will be confirmed approximateiy ten(10) <br /> days after receipt of application. The files will 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 be immediately available for review. A new application may be <br /> 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 applicant <br /> Future fele reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EHD U8E ONLY <br /> 48 0 <br /> 8127M <br />