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9 ECC VEL) EHD LOG NUMBER <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY • <br /> DEC. 30 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ALHEAL <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENT <br /> PERMIT/SERVICES %Iephone: 209 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECO"S RELEASE APPLICATION �pJl <br /> APPLICANT: USINESS/AGENCY: E `J <br /> ADDRESS: 1 I CITY/STA E/ZIP: / <br /> PHONE(1).. PHONE(2): ^� FACSIMILE: ' 3'�� y <br /> Phase allow 10 busigess day!;from date of application submittal for the records to be available. <br /> Staff will contact you to arrangejFAjS)rj=EQUEST <br /> . toren date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$ PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ZZ <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD SE LY <br /> Street# Street Name City ° M Upit 1 I <br /> 1 3`77 t �p 2 <br /> 0 0 ilrti t 3❑Uni <br /> NgWm I T,,rt70<,o& <br /> 4 cvot)4�733� (p(y <br /> nit 3 <br /> 5 I 2 — vw to nn ,(A) f ® ir3LV <br /> 6. Iq <br /> QQ I Hol M nit <br /> f8' -)61 sPr O P OA yunetyaAabl'eP'f•Gi"5 / Gf'I 0 f ❑ Unit 5 <br /> 9. Q s 4)Lxs2. <br /> 10. <br /> ❑ unit6i <br /> Specific Date Range of Information Requested: From to7,77 <br /> f ENVIRONMENT L HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> THEIR CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT El WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY El DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ,fHAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES�7 /' <br /> F1TATTODIBODY PIERCING ZOMPLAINTIRESPONSE RECORDS OTHE"'"LEASE SPECIFY) r7 / 4 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIOAY ��1�1�5 <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 'y .�,,��, <br /> box(es). At least one file type MUST be selected. Fax to(209)464.0138 or mail to the address indicated above. Addres <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. I <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 /> -1S5 - 1 MPS,- 4�u3-7 Pn uewWtsf z040 5C, <br /> • <br /> ❑ Records provid d by Staff-PPR Cohiplate. <br /> CtafName: <br /> EHD 48-06 f/ r 6 �e.S117117f <br /> S/74 <br />