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fj <br /> From:Marcus H. Bole & Assol,.—�tes 530+633+0119 05,.,/2012 10:22 #239 P.001 <br /> DATE EHD LOG NUMBER <br /> SAN .10AQUIN COUNTY <br /> Rec�-- D <br /> ENVIRONMENTAL HEALTH DEPARTMENT �J <br /> 1$ 2012 600 East Main Street, Stockton, CA 95202-3029 <br /> 0N, Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd f1 <br /> �rIVIRONMENTR�C SLTH PUBLIC RECORDS RELEASE APPLICATION U <br /> P <br /> APPLICANT: (7C u a BUSINESS/AGENCY: G t D <br /> ADDRESS: C) C �c t/ City/State/Zip ��� e✓! �t����� <br /> PHONE(1): 0 PHONE(2): ��O �S _3 Com) FACSIMILE:^b j <br /> TENTATIVE*APPOINTMENT DATE: `--R O AI W-Y Time: <br /> (Please allow 10 business days from date of application submittal I*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQ T-$105 FEE CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 B SINES DAYS <br /> SIGNATURE OF APPLICANT ��.� DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> -it <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City El Unit 1SMON <br /> 1. <br /> 3. 3 S Aim <br /> 4 /`V/ /El Unit 3 <br /> • _ <br /> DI 5 d Unit 4 ' <br /> 6. ( _ jLR (gym n i r n, dLzh� ro <br /> • 7• ' -- CL- 0 s cT� -Al D ❑ Unit 5 / <br /> a. tj 60 LlQ sr fg,- N� <br /> 9. oLeG4z to.5t ' Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested:From AA/y FILO ���5L to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT SOLID WASTE FACILITY/VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY AV1IASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL 12 DAIRY <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY M MOTEL/HOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA ��r❑� ND USE APPLICATION SITES <br /> P MEDICAL WASTE FAciLITY OTHER(PLEASE SPECIFY) l� �,�--�I--fid'✓t C <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 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 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 END 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 U5 ONLY \� <br /> s 1�1S r acv E12 <br /> ab 1 r del d <br /> EHD 48-06 8/04/08 PUBLIC RECORDS RELEASE APP FORM <br />