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z0'd 14101 0 . <br /> DATE RECENEDQQ�f SAN JOAQUINOUNEHO LOG NUMBER <br /> WCCI l v ED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 L <br /> APR 2 j 2009*elephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org d Q <br /> ENVIR(19MENTHEALTH PUBLIC RECORDS RELEASE APPLICATION. <br /> APPLICANT: 1 AA ''Or r� o BUSINESSIAGE/Ncv: <br /> ADDRESS: SM) IV. W:Ife . bC. e A CitylStatelzipr� <br /> PHONtE(1): Z l) fila( 'PGOA PHONE(2)!,f� 7ZA Am <br /> -Z. i/ FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: /✓la f� l A Time:j�4 <br /> (Please allow 10 business days from data o�n submittal--Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 0-74- 01 <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street! Street NameCity © Unit t <br /> � <br /> 2. QTT_pT �, p O Unitz <br /> a. 2b - w <br /> _-..-._..�— n4.. <br /> 5• U <br /> t 4n <br /> s. 2r+��o /������,.�..._dam• -��5 <br /> ❑ Unit 6 <br /> 8. <br /> 9. .__.___.... ..._-..------ ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From eNr1.1cir to t1 r,4} /'Coln} <br /> '''',,,,....///J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> g;*NDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 HGu$IN6 ABATEMENT D SOLID WASTE FACILITYNEHICLE <br /> .J7�7t'/U'�THER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑WASTE TIRE <br /> __IIyyrq'MrkGROUND TANK(MONITORINGIREMOVAL) 0DOG KENNEL (3 DAIRY <br /> $*AZARDOUS WASTE GENERATOR C3 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL 0 PUMPER TRUCKNARD/CHEM TOILETS <br /> D TATTOOIBDDY PIERCING ❑POOLISPA D LAND USE APPLICATON SITES <br /> 173 MEDICAL WASTE FACILITY D OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-6:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten 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 t0(209)464-0138 or mail to the address indicated 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 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 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 /> EHD USE ONLY <br /> EHD 48-06 8104/08 PUBLIC RECORDS RELEASE APP FORM <br /> E0lz0'd 66TO 998 SZ6 T Q31Cb0da00Ni 030ND 22:9T 6002-TE-adti <br />