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"It LIVE® <br /> DATE RECEIVED EHD LOG NUMBER <br /> DEC. 3 0 2014 � SAN JOAQUIN COUNTY � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEAL 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIrUSERVICES lephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd' 6 <br /> PUBLIC RECORPS RpLEASE APPLICATION /\ <br /> APPLICANT: tt SINESS/AGENCY: f/ <br /> ADDRESS: i,\,Q��, CITY/STA E/ZIP: <br /> PHONE(1).- - PHONE (2): FACSIMILE:_ <br /> Please avow 1U busl6ess dayb from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an ap el/gtmen date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$� CAS CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS D YS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map–Description: <br /> FILE ADDRESS EHD SE LY <br /> Street Street Name city ' M <br /> 1 3 <br /> 6z OGS o ;tom ,g <br /> 3. Jj L % ( tri a Nvn I 1,ND c0�i <br /> 4 2 s <br /> cvoU�33S l0/yme3 <br /> 56. <br /> — ✓Io t o M `7T o iI3�D �� <br /> a. -)by 5 r P I 2 s i <br /> ❑Unit 5 <br /> 9. <br /> ,� sses r2. <br /> 10. <br /> ❑unit s <br /> Specific Date Range of Information Requested: From3 to <br /> ENVIRONMENT I_HEALTH DEPARTMENT FILES <br /> ' UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> THER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT <br /> MONITORING/REMOVAL [j WASTE TIRE <br /> Zj UNDERGROUND TANK <br /> ( ) El FACILITY El DAIRY <br /> 'ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ,[HAZARDOUS WASTEMAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA rrr❑��pppLAND USE APPLICATION SITES <br /> F1TATTOO/BODY PIERCING �OMPLAIN 1RESPONSE RECORDS y�OTHE^-LEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAY ry� <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 1 -{S,/ �, <br /> box(es). At least one file type MUST be selected. Fax to(2091464-011or mail to the address indicated above. Addres <br /> ranges will not be accepted.Applications received after 3:00 PmWwili 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. i <br /> 3. 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 /> 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$125 deposit prior to review. *°*BOXED AREA-EHD USE ONLY*** <br /> • <br /> —I S' I M10 Fo/- /P t.13-I 24 "W W1 ,� <br /> ❑ Records provid d by Staff-PPR Co plete. Staff Name: <br /> EHD 4M6 <br /> �!S'12PS'n, <br />