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'29,120111 0/N�OT1 03: 47 PIS �0 — Public lor[cs PAX NO- 200--937-8277 P. 002 <br /> 1.1/29/2010 11:36 209 138 ENVIRONMENTAL #H _ PAGE 02/02 <br /> DATE RI;C EHD LOG NURSER <br /> ED $IAN.�t�AQU1N COUNTY @- 1115 <br /> ENVIRONMENTAL.HEALTH DEPARTMENT <br /> 9 201Q 600 East Main St. Stockton, CA 96202.3029 <br /> NO J 2 Telephono: (209)468-3420 Fax: (209)484.0138 Web„.www_sjgov.org/ehd <br /> ENTAL ViEALf1' PUBLIC RECORDS RELEASE APPLICATION <br /> i <br /> APPL <br /> PER <br /> t o / �7o Gv vN�^ 13USINESSIAGENCY, <br /> ADDRESS_ 02 e6�r,�t�e. S r 1' oor GiTyISTATEIZIP. ( 7061ZIC 1, CA t `�J�Q- <br /> PHONE(1): 0 J� �'� PHONE(2); FACSIMILE: �� ��^-�r, 7 <br /> TENTATIVE”APPOINTM NT DATE: Time: <br /> (Please allow 10 business days from ate of application submittal-'Tentative only-must be con rm� <br /> [71 CHECK BOX TO OXWEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-i3EQUEE`r PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronlc Information; Q List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> straat O Street N s City ©Unit 1 <br /> [2. fn - AtyI�P117 Unit 2 <br /> t%. <br /> 6. ® 2411t 4 <br /> T. V-W . . t l!i l �✓ /A)a <br /> 8. - d Unit s <br /> 9. <br /> 10. nit 6 <br /> Specific Date Rangy of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT Fi0=S <br /> S®UNDERGROUND TANK(IJWn CLUANUP SITE(LOP) Hous1NG ABATEmEw ❑SOLIDWASTE FACILTTYIVEHiOLE <br /> [ad HLR CLEANVP SITE(NON-LOP) HFOOP FAGILiTY ❑WASTE TIRE <br /> E-UNDERGROUND TANK(MON"PJN(3lREMYAL)O( []DDG KEKr.L DAIRY <br /> EA-HAZARGOUGWASTS GENFiRATOK n CHICKM RANCH HWASTEwATFRTRuATm%TFLAKT <br /> TIERED PERMITTED PACILITYVI ©MOTWHOTEt. ❑PUMP611HTRUGKIYARDICHEMICAL ToiLEi$ <br /> TAT1001900YPiMCiN6 ❑P00118PA [I LAND UsEAPPLiGNMONSITE$ <br /> W MEDICAL WASTE FACILITY [j OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARK AyAu-ABLE FOR Ri=yTEW., MONDAY-PRIDAY B.GD AM-O',QDPM(EXCLUOiNG HOLIDAYS} <br /> 1. List up to ten addresses In the space above. Select the typo(s)of flies from the 141t wbove by oheoking the appropriate <br /> bax(ov). At least one file typo MUST be selected. Fax_o f2l>91 AWla§gr mall to the address Indicate_ d abtFVR� Address <br /> ranges will not be accepted-for addttlonal assistance with file addresses,contact the FHD. Applloationv rorfolvotl pftor <br /> 3:00 pm will b4 pracciasgti the next business day. <br /> 2. The ZHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(1 p) <br /> days after re"Ipt of elpplication. The flies will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly, <br /> 3. A file that is alctivgly boirig worked on by EHD staff may not bo iMModiately avaiiable for review. A now application may be <br /> submitted when the file is avrailablo, <br /> 4. Any filo not rotmmod In the same eondiuon as.released will bu reorganized by EHD staff at the expense of the appiiaant. <br /> Future file reviews by the wmp atppliCaot may require a$192 deposit prior to review. <br /> �Hn U$E ONLY <br /> Ewa 0,69 <br />