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[u 10 / 2 : y2PM No. 0894 P. 1 <br /> Q Q g(E`R CEJ ED f l'/ ( ��-'1 <br /> L� 0 \,/ Cs.�� �� EHD LOG NUMBER <br /> ti SAN {OAQUIN CO <br /> G P ENVIRONMENTAL HEALTH <br /> H ,AUL C 4 2(.tk.a 1868 East Hazelton Avenue, Stockton,CA 95205-6232 qbgl <br /> Telephone: (209)466-3420 Fax:(209)464-0136 Web:WWW.sloov.org/ehd <br /> EhNgRCT,NiL_9*4TAL FIE.LTty PUBLIC RECORDS RELEASE APPLICATION <br /> L4 i!➢ ' .1.= V <br /> APPLICANT: t.+ Eva- BUSINESS/AGENCY: G��},S (:rtI/)rorL.+Ye <br /> ADDRESS: CITYlSTATElZfP: t.( y <br /> PHONE(1): .S(0-�N 7-9$8 S'".fSQ�')_ PHONE(2): FAX OR E-MAIL (*7 e,ra C t Z <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact YOU to arrange an appointment date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQUF,,ST- .;O FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT -!✓// DATE -7-(.4q—/(Q <br /> 1. List up to ten addresses in the space below. Select the type(s)of files from the list below by checking the appropriate <br /> box(es). At feast one file type MUST be selected. Fax to(209)464-0138 ormail to the address indicated above Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in Identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notary the applicant If any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The Was will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly, - <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$130 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0013M(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From At I to <br /> ENVIRONMENTAL 1 <br /> y /, dA l ,]- <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILESHp USE ONLY -7 �$ W <br /> Rua-ER_G 0 N0 TANK(UST) $treat# Street Name city <br /> CLEANUPSM,(LOP) El J� MA <br /> ❑CONENYii <br /> IIIII OTHER CLEANUP SRE(NON-L07) ' 3 I30 S, o r p (,l'rL <br /> HLlARpOU$WaSfE rr(( �`'/ -o- <br /> S�tS G\ Cdr � two <br /> "rTIERED PERMITTED ABOVEGROUNp TANK 2 V'\ <br /> //x�UST(MONITCRINO MATERI LUi 9 ms 'S• 1 ,, rHalaR0005 MnTERIAl3 � (��a,'.p 6prj`C.36V�SPttURELEA6E Re6PON6E <br /> SOLID WASTE FACILT'/VEHICLEA WATEROW.LITY +�(� <br /> f Uhf( <br /> FOOD FACILITY 1""`i '�G•\I'/YI Ey /�/-�• • G'�f�•\ LY / IvOW�yP \vVON <br /> I]POOL/SPA ITE MrtIIiATW <br /> DAIRY E <br /> rJI LAND UEE ApP,LIGTION SITfS <br /> (�SEPnc PUMPER TRUCK/ ❑Ho1sINE <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> wMMEMUTER TREATMENT PLANT <br /> CVPA <br /> 0HOUBINOAEATE.GKT T <br /> ❑MOTEL/HOTEL <br /> n CNICNEN RANCH/POO KENNEL <br /> e J <br /> MEDICAL WASTE FACILITY ' <br /> TATTOOIBODY PIERGNG <br /> R'�LLNI WAEiE <br /> AWAI�WASTE TRE E <br /> .-TE <br /> OTNER(PLEABE SPECIFY): - ❑AcccUNnlw <br /> 10 <br /> •••BOXED AREA-END USE ONLY"' <br /> O D s <br /> rout d 45 e= <br /> ❑ Records provided by Staff-PPR Complete. staff Name: if <br /> Received Time=Jul. 14. '2016-12: 55PM4 No. 0973 <br />