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Ta: Page 3 of 3 1 2014-05-21 18:14:25t5I � C (D <br /> Vf1yUF1v ` 'DAL 0SAN JOAQUIN COUNTY <br /> AUG 21 'f CIA ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868'East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTALTi@Irp"ne: (206)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd r <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: z o�Lop BUSINESS/AGENCY: <br /> ADDRESS: 6-6-� } \f n1{BSc Q! �� CITY/STATEEMP: �j«�° �� r t�1T <br /> PHONE(1): Vf &O S 93(RO PHONE(2): $O S T-01 Li' M 0 FACSIMILE: /J h4S 5(?I/P�6,,,r <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 EXPEDITER QUEST st25 K ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: . ❑ List❑ Map–Description: <br /> FILE�ADDRESS EHD USE ONLY - <br /> I/\ J Street#i S et Name city -Unit 1 , <br /> 1. )030 V- A i�t�J[. }p }pmt 61 M �eccS� <br /> p MM <br /> 2. L 7 y _ Unit2 <br /> 3. <br /> 4 ,016nit 3 <br /> 6. ,.'i V Untt4 <br /> 7. q �, <br /> 6 .Q Unit s <br /> 9. <br /> 0 Q-Unit& <br /> Specific Date Range of information Requested: From <,,. r to _ <br /> ENVIRONMENTAL HEAL H DEPARTMENT FILES <br /> ,UNDERGROUND TANK(UST)CLEANUPSRE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE Flfe�q., <br /> 90THER CLEANUP SITE(NON-LOP) gHDusINGA9ATEMENT FWASTETIRE 3 <br /> IKUNDERGRouNO TANK(MONITORINGIREMOVAL) ❑F0013 FACILITY 19DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ILy WASTEWATER TREATMENT PLANT C '7 <br /> HAzmous WAsTE1HAzARDOUS MATERIALS ❑MOTELIHOTEL PUMPER TRUCKIYARDICHEMICALTOILETs <br /> TIERED PERMITTED FACILITY POOLISPA LAND USE APPLICATION SrrEs <br /> ❑TATTOOIBODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B;00 AM-S.00PM(EXCLUDING HouDAys) <br /> 1. List up to ten addresses in the space above. Select the type(s)of flies tram the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 7209)484-0138 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 it 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 fora maximum of five business days for review. Appointments <br /> should be scheduled according)F. <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 pplicant may require a$125 deposit prior to review. ""'BOED XAREA-EHD USE ONLY <br /> ❑ Records provided by StaffpPPR Complete, staff Name: <br /> 4[26114 <br /> ENO 4&08 <br /> Received Time AU9. 11. 2014 4: 14PM No, 6887; _ i <br />