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tf U � EHD LOG NUMBER <br /> RWED <br /> SAN .10AQUIN COUNTY <br /> 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> Ark600 l=ast Main Street, Stockton, CA 95202-3029 <br /> ENVIRMMENT HEAM-Olephone: (209)468-3420 Fax, (209)464-0138 Web, www.sjgov.o <br /> PERMITISERVMCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I N a O i BUSINESSIAGENCY: CS_E_ _D <br /> ADDRESS: C-so- V. Wiliga, AVt- 5reA City/Staterzip IQ C0' <br /> PHONE(1): ZDq QF, .71 (2): ,24A- <br /> � <br /> PHONE(A2)): .7� �ZL — 2�OS� FACSIMILE: — — <br /> TENTATIVE"APPOINTMENT DATE. MOS rC�, ri Time:.. <br /> (Pleas®allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE T- 0 EE(CASH OR CHECK ONLY),REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: 0 List❑Map-Description: <br /> _ FILE ADDRESS _ _ EHD USE ONLY <br /> Street Name City <br /> �. 14 01 C ST. -(moo F, F" <br /> 0 Unit 1 <br /> 2. �1.�. /�QSL� ` /L4a e <br /> � <br /> CW _.. ...,.. �� Ic d Unit2 <br /> 16 `i. . il! e• vc lr. ._...I.. Unita <br /> aao a� �, G ,U <br /> Ad-JAJ�.._..,.......,.:,.......,...�. 95D :. 3..5 _. _ <br /> nit <br /> • � i n M(F ; . 5Z� � �� � � <br /> - aj hUnit 5 <br /> 10. CA d i.A C01 • ANC-.6,19, - t <br /> Specific Date Range of Information Requested:From Car lle$- to rMo-4 reCe/ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILIiYNEHICLE <br /> 15 <br /> XOTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> .UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL 0 DAIRY <br /> X,HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY C1 MOTEUHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING 0 POOLISPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WALL 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 he 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> END 48-06 8/04/08 PUBLIC RECORDS R£LEA$EAPP FORM <br /> EO/TO"d 6610 998 SEG T Q811Ja0&100NI 030N3 22:9ti 6OOE-TE-NdU <br />