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DATE RECEIVED RECEIVED FHD LOG NUMBER <br /> SAN ,10AQUIN COUNTY _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT 5g 9 g 7 <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> AIS 0 5 201felephone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sigov.org O�M <br /> EN100NMENTALHEALTH PUBLIC RECORDS RELEASE APPLICATION LL1J <br /> APPLICANT:LAf? iL BUSINESS/AGENCY: AR.Qu5* j Q'56 <br /> ADDRESS: `Ilagw CITY/STATE/ZIP: 1A <br /> PHONE (1): `i'S 7 PHONE (2): FACSIMILE�5 3,e; <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE RFISVEST-$115.00 FEE SH OR CHECK ONLY)-REQUEST PROCESSED I 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT � =Q DATEJ[15" <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name Cit), <br /> 1 ©� ❑Unit 1 <br /> 2. <br /> 3. - Unit 2 I IIq <br /> 4. ` , 7 <br /> 5 S /• V ❑Uni[3 <br /> s. per- V eG <br /> 7. ❑Unit4 <br /> 8. <br /> DGe- <br /> 9 1 LI ❑Unit 5 <br /> 110. o �7 <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> E]UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL 11105❑ STER TRUCATER TREATMENT PLANT <br /> ❑TATTOOIBODY PIERCING PUMPER TRUCKICARON SITES AL TOILETS <br /> ❑OTHER(P [I LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List u0 to ten addresses in the space above. Select the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(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$115.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If <br /> YOU need further assistance Please contact Diane Martinez direct) @ (209)468-3425. Thank You*** <br /> can ensc <br />