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00/[0/2014 14:47 FAX AMIN U002/002 <br /> RINW <br /> DATE RECEIVED EOF., <br /> OI SAN .IOAQUIN COUNTY o9 ;. 9Il ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> AUG 2 6T4Qhone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> �,..,_,,j%nPmTALBEAPUBLIC RECORDS RELEASE APPLICATION <br /> FF ,.a � s 7 1 <br /> APPLICAW"I t o I-f0 BUSINESS/AGENCY- e Cons. I'1-^, L <br /> ADDRESS: gv%"Ocic t. pp CITY/STATE/ZIP: )C l ) CO <br /> PHONE(1): PHONE(2): _)Q p .'j -O f5p$ .3 FACSIMI : <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. dO <br /> CHECK BOX TO EXPEDITER EST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTµ. DATE 9 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City ❑unit 1 <br /> I 1. t4uP t Jcu jp <br /> 2 R� acv. <br /> S iMM Unit2 <br /> A unit 3 <br /> �5• L> <br /> 6. Uv ! L( 1tlT' Llty51; 83- 1 mt4 / <br /> 7. <br /> 9. ❑Unit s <br /> 9. <br /> 0. Unit S <br /> Specific Date Range of Information Requested: From OD to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ❑ P <br /> RUNDERGROUND TANK(UST)CLEANUP SITE(LOP) [I MEDICAL WASTE FACILITY SOLID WASTE FACIUTYNEHICLIE <br /> 2'6THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> 2.ONDERGROUND TANK(MONITORINGIREMOVAL) ElFOOD FACILITY ❑DAIRY <br /> lDV'1V ,a <br /> 'ABOVEGROUND TANK L] Elc <br /> CHICKEN RANCH/D00 KENNEL WASTEWATER TREATMENT PLANT &-9'` <br /> Q'HAZIIRDOU9 WASTE/HAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILrrY ❑PO01./SPA ❑LAND USE APPLICATION SITES <br /> E3TATTOO/BODYPIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8100 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addressor In the apace 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 mall 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 notifythe applicant If any EHD files exist. An appointment for review will be confirmed approxlmately 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 /> L21-1 R7 ,EAici r,,nii c.r inciricap <br /> c-F e z - Z G <br /> ❑ Records provided by Staff•PPR Complete. Staff Name: <br /> EHo ta.ae azmt <br /> Received Time Aug. 20. 2014 1 : 51PM No. 6874 <br />