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DATRECEIVED EHD LOG NUMBER <br /> SAN ,�oAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 96202-3029 <br /> 'L Telephone: (209)4683420 Fax: (209)464-0138 Web: www,sjgov.org/$dSl <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _�SD r^I a � <br /> ..,,... 6USINl=SSlAGENCY: <br /> ADDRESS: / CitylStatelzip <br /> PRONE(1): z9hol)q0-650 PHONE(2): T2A FACSIMILE: <br /> TENTATIVE*APPOINTME ATE: ime: <br /> (Please allow 10 busine s y m date of application submittal-"Te War ve only-must be eonflrmad) <br /> CHECK BOX TO EXPEDITE R Q T-S 05 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE )GC- 222,00S <br /> Electronic Information: Q List[J' Map—descriptions: <br /> FILE ADDRESS 1=H0USE 0 N L Y <br /> street# strootNarpe.. <br /> 1. � Unit 1 <br /> r ES <br /> 011 <br /> 2. <br /> Unit 2 <br /> .._ <br /> 3 <br /> 4 Unit s <br /> 7001 <br /> _.5_. <br /> 6. <br /> Unit 4 <br /> 7. _.., <br /> de <br /> Units <br /> 9. <br /> j.YUnit 6 <br /> Specific Date Range of Information Requested:From /' to <br /> / ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I!d' DERGRDUND TANK(UST)CLEANUP SITE(LOP) CIOUSING AkSATEMENT 11:140LID WASTE FACILITYNEHICLE <br /> HER-CLEANUP SITE(NON-GOP) 0400D FACILITY CPAVAsTE TIRE <br /> EEr�DERGROUNu TANK(MONITORING/REMOVAL) Cl`DOG KENNEL 'nC�V�+•AA., IRY <br /> F ARDOUS WASTE GENERATOR CHICKEN RANCH i{ 6TEWATER TREATMENT PLANT <br /> ( JERED PERMITTED FACILITY 0T`MOTEUHOTEL qffo R TRUCK/YARDtCHEM TOILETS <br /> [1 ,A� TTOOIBOGYPIERCING QPOOL/SPA USEAPPLICATIONSITES <br /> M-MEDICAL WASTE FACILITY C3I CdyHER(PLEA5E SPECIFY) <br /> WELL AND SEPTIC PERMITRECOADS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY B:04 AnM-$;40PM • EXCLUDING HOLIDAY$, <br /> 1. List up to ton addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 209 464213$or mail to the address indicat d 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 clay. <br /> 2. The EHO 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 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 /> -- -EHID U_';�€ Y <br /> -�_ I- <br /> A 4 <br /> EHD 40Z61104/00 PUBLIC RECORDS RELEASE APP FORM <br /> TO/T0 3JVd WV31 S30IAH3S _1Idl3a 8LL89bb9TS TZ:LT 800Z/6Z/ZT <br />