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d � 6.vxi n•�� .�r�� i iLr����� f�ri�a� fal <br /> TY <br /> ONMENTAL HEALTH DrPART AMW <br /> 304 East Weber Ave> ue, Sia Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-34?0 Fax:(209)464-0138 Web:www.sjgov.org ehd <br /> °/ DUBLIC RECORDS ULE <br /> A,SE APPLICATION <br /> APPUCANT: K <br /> i L - aled-- <br /> RUS(NESSIAGENCY: V.0 _ <br /> A�Dti��ss: 3�to tA�_ N C!�{ -- <br /> PHONE(1): PHONE(2):ti ? ( FACSIMILE: <br /> 13q 77 27 <br /> TENTATIVE`APPOINTMENT DATE:- 1 0(, ' - <br /> �' (Please ailow 1 o business da f Time: M a,r <br /> S's from sate of 2PPlication submittal-'renta6re only-must be conn ed) <br /> C3 CHECK BOX To QCPED" 3 F <br /> T( !M CtI1;CK ONLY)—REQUEST PROCESSED 9N 3 BUSINESS DAYS <br /> ;ria.TURE OF <br /> - APPLICANT DATE t2/Zz/og <br /> ry)(ST mBU'noN D Unit 1 ❑Unit 2 ❑Unit 3 ❑Unit 4 ❑Unit 6 ❑ Unit 6 L3 Other(elecfxonlcJtistshnaps) <br /> ADDRESS <br /> Street Streat Namecity EHD USE ONLY <br /> 1• 11 1 +� o®.d <br /> 2 <br /> Al RF X157 <br /> 11 <br /> u.e w d <br /> 3: 8�+ <br /> 6. <br /> L0. <br /> fic Date Range of information Requested:From to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> 0010SAGRcKMD TANK(UST)•CLEANUP trTE(LOP) ll0tlS(ttc:/�gA�M $pt 1e Wpc, FAC�tTYNENICLE <br /> OTHER Cta:arlup SITE(NON-LOP) FOOD FACtm 0 WASTE Tule <br /> UN ERGROUND TANK(MON TORING-IRWOVAL) EI Doo KENNEL ❑DAIRY <br /> ` HAZAP.DOUS WASTE GENERATOR G CKEII RAMH El WASTEWATER TREATMENT PLANT <br /> TiEP..'3D PERurrTED FAcuTY 0 O C3 PUMPER TRUCKlYARDICE1fi4A TOILETS <br /> TA?TX�OpY PIERCING '®POOMPA ❑LAND USE APPLIQATm Sam <br /> 0 MW.AL WASTE FACflZY O R(P��E SPECtFtf) <br /> W5LLL NO SEPTIC PZ%MtT RECORDS ARE AVAILABLE FOR REMW- MONDAY-FPI Chk*6:04 ANt•6:00PV - EXCLUDtW HOUDAYs.. <br /> t up to ten addresses in the space above. Select the-4'00(s)of files from the list above by checking the _ <br /> f ropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address <br /> =_i::<fed above. Address ranges will not be accepted—for additional assistance with file addresses,conts;;:; <br /> PD.Applications received after 3:00 pm will be processed the next business day: <br /> } :AHD will notify the applicant if any EHD files exist✓ An appointment for review will be confirmed <br /> r)xSmat©ly ten (10) days after receipt of application. The files will be held for a maximum of five buslnc; <br /> a;,s for review. Appointments should be scheduled accordingly. <br /> �T:c that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> <:.P pdcatlon may be submitted when the file is available. <br /> iy file not returned in the same condition as released will be reorganized by EHD staff at the expense of thy,, <br /> )plicant, Future file reviews by the same applicant may require a$93.00 deposlt.prior to review. <br /> 3'.�• '.J <br />