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DATE RECEIVED9SAN JOAQUIN COUNTY • <br /> �g a <br /> �1 � x� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> hOV 18 21,1 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> tinnr�rtvar=;4ir:I_hrfi.i_T!{ PUBLIC RECORDS RELEASE APPLICATION <br /> PErratT/sEafll' <br /> APPLICANT: BUSINESS/AGENCY: S <br /> ADDRESS: T�riNy lbuirW .7"wt'_ &Art A CITYISTATE/ZIP: .5'Ct�d (A 9z1� <br /> PHONE (1): PHONE(2): FACSIMILE: <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 REQUEST-$13 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE j I� <br /> Electronic Information: ❑ List ❑ Map– Description: <br /> FILE ADDRESS EHD USE ONLY <br /> (:�i. A Street# Street Name city I <br /> ❑ Unit 1 <br /> 1. 21)55 I ndusiyimpywe, 'SbaAw CS H E No�'P w-ok 3 <br /> 2. { �Y <br /> [J Unit <br /> 3. <br /> 4' p unit 3 <br /> 5. / <br /> 6—_ 1�]-vad a- <br /> 7. <br /> 8. <br /> . .. .. ... . ,-. .. . :: . - . Units <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From - to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ( � <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE. lUlJi <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING AB ❑WASTE TIRE <br /> ATEMENT �' 3 <br /> ,1�' <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY �I"" <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL []WASTEWATER TREATMENT PLANT 17. <br /> �]HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA IgLAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑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 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 to(209)464-0138 or mail 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 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$130 deposit prior to review. 'BOXED AREA-EHD USE ONLY"' <br /> ❑ Records provided by Staff-PPR Complete. staff name: <br /> EHD 48-06 08101114 <br />