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( F orri-CRA-Ci�fCAGO 42 773-360-6421 T-349 P.02/02 F-506 1 <br /> LU�U a7HIV +1VHL,(Vi1V IiVUIV 1 T <br /> JUL 0 A LU 11 EWRONMENTAL HEALTH DEPARTM t <br /> �NVIRpNMHEALTH none; (209)4 8600 -3420 Faxst Main : (209)484-0 38 Web. Stockton, CA 30 www_sjgov.org/e d <br /> 29 <br /> pERMtTISIES�tiRVICE� p <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; E rt'av) _&e ve BUSINESS/AGENCY: Ca .._2nxe4 .£ A 55 ia-k' <br /> ADDRESS: O l fljjc h . S CITY/STATi=1ZiP: P21Aq5!f <br /> _ . PHONE(1): 6 S1 b 39 G I PH(]NE (2): r FACSIMILE: <br /> -- TyliT <br /> TENTATIVE-APPOINTMENTDATE:�no3- vr�,e.�n/ ilr� -,n MN) W bt, rna�e? <br /> (Pleaso atlo,m 10 business days from date of application submittal-•Teniadvonly be confirmed}W� re',,,, ursC 4o� <br /> ❑CHECK BOX TO F_SF'EDITE REQIL7 <br /> ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 13UsS�INESS DAYS aN f ee5 <br /> SIGNATURE.OF APPLICANT DATE <br /> Electronic Information: ❑ List© Map–Description: <br /> _. FILE ADDRESS EMD USE ONLY <br /> - Street# Street Name Cily <br /> —lo 13 43 <br /> 2. 15 .� 11i1 i ' <br /> nit� <br /> A3. — – <br /> 4. <br /> -- — nrt.4 �A\ <br /> 7. <br /> 9. _. —_ ____.._ Units <br /> 10. -- <br /> ❑unit 6 <br /> Specific Date Range of Information Requested: From Ali 7;i Its to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NUNDERGROUND TANK(UST)C1 EANUP SITE(LOP) []HOUSING ABATEMENT f7p SOLID WASTE FACILITYIVEHICLE <br /> MOTHER CLEANUP SITE(NON-LOP) ElFOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITOItiNGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ALARDOUS WASTE GENERATC,H ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL <br /> [,�PUMPER TRUCK/YAROICHEMICAL TOILETS <br /> Lj TATToo/BQDY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASC SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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(cs)_ At least one file)type MUST be selected. Fax to(209)464-0138 or mail to the addrass indicated above Address <br /> ranges will not he accepted-for additional assistance with file addresses,contact the EHID. 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 avallable, <br /> 4, Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of tho applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> S. If you meed further assistance,please contact Diane Martinez,at(209)46"25. <br /> eko use ON4v <br /> EH 448-06 <br /> 0127/09 <br />