Laserfiche WebLink
3 <br /> 05/03/2006 11;34 209-579-^^ 5 MODESTO ATC PAGE 02 <br /> t) Qof us �s <br /> DATE RECEIVE-0 F""LOP' <br /> SAN JQAQtJIN�:fJrt1NTY <br /> MiOcl <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3'd Floor,Stockton,CA 95202-2708 <br /> Telephone;(209)468-3420 Fax;(209)464-0138 Web:www.sjgov.org/,.hd Z0351 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:D1 „�} , BUSINESWAGENCY: A sI <br /> ADDRESS: It 0 1 a W ti_ jam, s 1-, '•y-�-•� A. �� A� <br /> PHONE(1):%l 0-575, ..� TI_1 PHONE(2): ......FACSIMILE: !tn <br /> TENTATIVE'APPOINTMENT DATE: ��sl•CNS Time: RAP- <br /> (Pleas*allow 10 business days from dabs of appliuldon submittal-"Twrt rMm only-must be confirmed) <br /> CHECK BOX TO EXPE TT $93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAY0 <br /> SIGNATURE OF APPLICANT 04 DATE <br /> UNIT D STUB& N 0 Unit 1 n Unit 2 Unit? 0C unit 4 0 Unit 5 prunk 6 0 Other(*t*ctrerr ICAIt-tarnraps) <br /> FILE ADDRESS EHD USE ONLY <br /> Strait* Stoat Nam city <br /> 2. 1 r <br /> iss4 - ... <br /> 7. <br /> S. <br /> 9. <br /> 1 ti. <br /> Specific Data Range of Information Requested:From to � <br /> ENVIRONMENTAL HEALTH DEPAUMENT FILES <br /> UNDEROROVNO TANK(UST)CLEANUP SRE(LOP) 0 HousINO ABATEMENT ItSOUD WASTE FACILrTylVEHK:LE <br /> OTHER CLEANUP&m(NON-I.OP) 0 FOOD FACKRY 0 WASTE TWE <br /> UNDERGROUND TANK(MOWTORINO/RtONAL) 0 DOG KENNEL 17 DAIRY <br /> HAZARDOUS WASTE GENEIsArOR 0 CMIGKPI RAM" 0 WAIITTWATER TRMNTMEW PLAKI <br /> .ISTII; OPERINITEDFAcaxir 0MOTEUMOTEL C3PumpeRTRucKfY00CHIMTOILM <br /> 0 TA7TO Movy PIERCING Q POOL ISPA 13 LANG UTE APPLICATION SM <br /> 15 MEDICAL WAAU FAcILRY 0 OTmeR(PuEAsa SP[CIFY) <br /> WELL AND SEPM PERNaT RECORDS ARE AVAILABLE FOR REV%W- MONDAY-PRIOAY 8:00 AM-5--09M . EXCLUDING HOUCAY& <br /> 9. List up to ten addresses in the space above. Seielet the type(s)of files from the list above by checking tha <br /> appropriate box(es). At least one fife type MUST be selected. Fax toLOS)484-0938 or mail to the address <br /> indicated above. Address ranges will not be accepted-for additional assistance with file addresses,C*ntad <br /> the EHD.Applications received after 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 <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively beim worked on by EHD staff may not be immediately available for review. A now <br /> Application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> ENa�aos� <br /> 117fWd' <br />