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-x g 30 11 01:33p Rich And Jod - c-35140703 ..__p.2__ <br /> ENVIHUNMENIAL r1t <br /> 68/30/2011 13:16 2094638 EH LOG NUfv19i=R <br /> DAR ���6oJ SAPI .SOA4l!(N COUNTY O <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0 2011 600 East Main St. Stockton, CA 96202-3029 <br /> AUG Telephone, (209) 468-3420 Fax: (209) 464-0136 Web. s3goy•org/ehd <br /> ENVP TH <br /> R SERA CES <br /> PUBLIC RECORDS REQ-EASE APPLICATION <br /> APPLICANT:/ BUSINESSfAGENCY; i <br /> CITYlSTATEIZIP;;2�f ' <br /> ADDRESS: ,;- 7 ��1�'If�ll�� I�r` <br /> PHONE (1)L (o PHONE(2):___ Time: <br /> TE(UTA Tf VE'APPOINTMENT"DATE: <br /> (Please allow 10 business days front date of appllcatian su6Inittal-'ienlaflva�lY-r►�ust be confirmed) <br /> ❑ CHECK BOX TO EXPE,01T REeUEs7;$t 25 EE(G�iSH OR CHECK OILY)-REQUEST PRQCfDASTEIN 3�6US0 S SAYS <br /> SIGNATURE OF APPIICA <br /> Eleetrontc Information: f -a Q Map—Description: <br /> EHD USE ONLY <br /> FILE ADDRESS - p unit I <br /> Street Name <br /> StreCity <br /> Street A ... .. .. — . <br /> Ito <br /> Unit Z <br /> 2. <br /> 3. �®f �;, •--- �1,^ ^ __ nit 3 <br /> 4. <br /> 6. <br /> 7. Unit 8 <br /> Unit 6 <br /> �-- <br /> spaclftc bete Range of Infamtaiian Re4ueaENVIRONMENTAL-HE TH DEPARTfiAENT FILES r �,, <br /> HDUSING ABATEMENT -C,Y�+LIDWA6TE FACILfTYIYEHICUE <br /> ;2 (UNDERGROUND TANK(UST)CLEANUP SITE(LOP) FOOD NG ABY _0VASTETIRE <br /> nQTHER CLEANUP SITE(NON-LOP) E DAIRY <br /> E UNUFOOD KENNEL ERGROuuo TANK(McwrommG)REMOUAL) ❑ RVASTEWATEA TREATMENT PLANT <br /> ,®,HAZM000S WASTE GENERATOR ®CHICKEN RANCH B'PUMPFRTRUCKIYARojCHEMICAL TOILETS <br /> ❑TIERED PEAMiTTED FACILITY[ ❑MOTEL(HOTEL �AptD us@ APPLICATION SITES <br /> OOLISPA (]OTHER(PLEASESPECV)]TATT00l60DT PIERCING OMPLAINT RECORDS MED CAL WASTE FACILITY <br /> WELL AND�ten <br /> PERMIT�intl <br /> O3 ARE AVAILABLE FOR REVIEW: MONDAY-FRmAY 8:00 AM-5:01)pm(EXCLVDING HOLIDAYS <br /> 1. est up ddce�sespace above. Select the type(s)of roles from the List above by checking the ave. Address istQ <br /> box(es)• At least one file type MUST be selected. Fax to 209 464 0138 or mail to the address ind;�ttQd above. <br /> daffer <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. App <br /> 3:00 pm wlll be processed the next business day. ten <br /> 2. The EHD will notify the appGCant if any EMU files exist. An appointment for neview�rrill be confirmed► vtewp Appointments (10) <br /> days after receipt of application. The files will be held for a maximum of five business day <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately avallable for review. A new application may be <br /> submitted when the filer is available. as released will he <br /> 4. Any filefnot iler retvrnad in the <br /> by the sarno condition <br /> applicant may require a$123 deposit priortooyrevieew.Staff d[ the expense of the applicant <br /> Fu <br /> Fno yqc ONLY <br /> 9J 1!t 1 <br /> 2Ho 40.06 <br />