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04/20/2007 16:47 CLAYTON GROUP 4 12094640138 NO.680 D©1 <br /> DATE RECENED EHD LOG NUMBER <br /> _ SAN,TOAQUJN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E. Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0)38 Web: WWW.sjgov.orZd735 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t- RUSINE5SIAGENCY: comk Ven CA�Q <br /> ADDRESS: EA 21� �-.7�C <br /> PHONE(1): 20�PHONE(2)' FACSIMILE: Q Q <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-ltenfafive only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST•$95.00 FEE(CASH OR CHECK NLY)-REQUEST PROCESSED IN 3 euslN SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street a Street karne, City Q Unit 1 <br /> 1. dCl rC 'Tracv <br /> ❑ Unit 2 <br /> Unit <br /> 4. s <br /> \\ <br /> 5. <br /> Unit 4 <br /> 6, <br /> 7, ❑ units <br /> 8. <br /> �. Unit 6 <br /> Specific Date Range of Information Requested: From to T e � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NWRGROUND TANK(UST)CLEANUP SITE(LOP) InHousma ABATEMENT *4601-10 WASTE FACILrYNEHICLE <br /> TmER CLEANUP SITE(NDN-LOP) © FOOD FACILITY ❑WASTE TIRE <br /> UNUFRr,ROUNOTANK(MONITORINGIREMOVAL) ❑ DOa KENNEL Q DAIRY <br /> iAZARDOUG WASTE GENERATOR M CHICKEN RANCH M WASTEWATeR TREAwENT PLANT <br /> *TIERED PEFty TTED FACILITY M MOTWHOTEL Q PUMPER TRUCK/YARDICHEM TOILETS <br /> *TATT00/BOt7Y NERciNO O POOLISPA ❑LAND USE APPLICATIDN SITES <br /> 13 MEDICAL WASTE FACILrTY Q OTHER(PLEASE SPECIFY) <br /> -WELL AND SEPTIC PERMIT RFCORDs ARE AVAILABLE FOR R"V w- MONDAY-FRIDAY 8:00 AN-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the types)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 r mall to the address Indicated above_ Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EH0.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHp 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. Appointmerrts <br /> ahould be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD=ff 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD aa.n0 911M006 wao <br />