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qTE RECEIVED i— LHU LUG NUMUtK <br /> SAN �� <br /> ENVIRONMENTAL HEALTH DEPARTM N I. , <br /> 600 East Main St. Stockton, CA 95202-30 <br /> eleiphone: (209) 468-3420 Fax: (209) 464-0138 Web. YT:1tgfav� rg/eh <br /> r-t`r /// <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I c t� Tr BUSINESSIAGENCY: 9 2-(c Z�o <br /> ADDRESS: 0 t/Z . c Z O CITYISTATEOP: t M�s6i <br /> PHONE(1): rj - (D - 39 PHONE(2): 51FACSIMILE:510-2c15 - 260569 <br /> TENTATIVE'APPOINTMENT DATE: r= _t 2 Zo 1 i Time: $q� <br /> (Please allow 10 business days from data of appllcatlo submitta `Te tatfve only-must be confirmed) <br /> CHECK BOX TO EXPEDIT QUE -$115 F H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU IN,ES✓S AYS <br /> SIG TURE OF APPLICA DATE (g ; � <br /> Electronic Information: I1 List Z Map- cript n: i roY,me J ort <br /> FILE ADDRESS to # EHD USE O Y <br /> Street ff Street Name City _ "", Unit 1 <br /> 1. 23O � Y) c� v�Shic. u2 ;�D <br /> 2. I� �Qf��t on I��_ �A" , l �Unit2 <br /> 3. 2- <br /> -s '�; � �., <br /> 4. (� Q Cf V2l I � T, w Unita I�� <br /> 5. 32-o `�l 5��-c)c 4"Oy AJ2 1 a <br /> 6. 2 W N1 Gl I T l �1i_, ,I Umt 4 <br /> 7. Vero, 1 q <br /> �'+W I ❑Unit s <br /> g. 3 �L I ��i V, - <br /> 10. n saXZld 1 Unit6 / <br /> Specific Date Range of Information Requested: From P Q r I I -C to 'j colse n <br /> ENVIRONMENTAL ALTH DEPARTMENT FILES _r <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> " TIERED PERMITTED FACILITY ❑MOTEL/HOTEL MPER TRUCKNARDICHEMICAL TOILETS <br /> `❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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 to (209)464-0138 or mail to the address 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 EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The tiles 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 file 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 USE ONLY <br /> ENn A9-0B <br />