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TO/02/2008 10: 17 FAY, <br /> QA��1�t ii V, .. <br /> COUNTY <br /> D SAN ,IOAUIN EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT - <br /> O C T 2 2008 BCU East Main Street;Stockton, CA 95202-3029 <br /> Telephone, (209) 468-3420 Fax:'(209)464-0438 Web: WWW.Sjgov.org/ehd [[ <br /> E1W RUN1JiENT HEALTH <br /> IVIIT)SERKES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS AGENCY: <br /> ADDRESS: �j GltylstatelzIp IC <br />` PHONE(1}_ '"! PHONE(2}_ FACSiMILE: �3 <br /> TENTATIVE*APPOINTMENT DAT : Mme. <br /> (Please allow 10 business day fro date of apps tion aubmktal="TentaUvs onl <br /> must aonflrm�d) <br /> Y <br /> CHECK 13OX TO EXPEDITE R QU 06 FEE CAS R ONLY)-REQUEST PROCESSED IN 3-6USIN S DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> ElectroniC Information: 0 List Map—Descrlpt on: <br /> FILE ADDRESS EHO USE ONLY <br /> S(reat# Stmet Name city <br /> 1. 010/ ^ry R 6 s�lr� El ft i <br /> Z o2. 57� Unit 2 jV I <br /> 3. <br /> 4, Unit T <br /> 5. ,n/ .. 11 <br /> J / IC o.-, ne) IF Unit 4 <br /> Ole <br /> 7 I y unit 5 <br /> 9. <br /> Unit 6 <br /> 10. O& -v V, O'.f 1 <br /> Specific Date Range of Information Requested:From 1 C4 H.0 I to - e <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDCRG Le"' TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT _ �e WASTE FAC1LfTYlVE111CLE <br /> HER CLEANUP SITE(NON-LOP) Q FOOD FAGLITY TE 71R[ <br /> =NDl=RGROVNO TANK(MONITonINGIREMOVAL) - I7 DOG KENNNL AIRY <br /> 1DOUS WASTE GENERATOR 0 CHICKEN RANCH - MMTER TREATMENT PLANT <br /> ,A TIERED PERMITTED FACILITY In MOTELIHATEL MPERTRUWYARDICHEM.TOILETS <br /> - O TATT001BOOT PIERCING M POOLFSPA No USE APPLICATION Silts <br /> M MEDICAL WASTEC FACILITY to OTHER(PLEASE SPECIFY). <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILAaLE FOR REVIEW-MpNDAY-FRIDAY 9:00 AM-6:00pM -ExcLuniNG Ho!_IDAYs. <br /> 1. List up to ten addresses In the space above. Select the type(*)of files from the list above by checking the appropriate <br /> box(es)- At least one Tile type MUST be selected-.Fax to(209)464-0121 or mail to the ad Msz indicated above. Address <br /> ranges will not be accepted for additional assistance with file addresses;contact the.EHD..Applications recelved after <br /> 3:00 pm will be processed the next business day, <br /> 2. The EHb will notify the applicant if any EHD tiles exist. An appolntmentfor review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held for a'makimum 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 file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> I <br /> EHD 40-06 910410E PUBLIC RECORDS RELEASE APP FORM. <br /> J <br /> i <br />