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DATE RECEIVED EMD LOG NUMBER <br />SAN .IOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />11.eceNeo 600 East (Main St. Stockton, CA 95202-3029 <br />VTelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />D�L <br />APPLICANT : +e r �P BUSINESS/AGENCY: 3_414.r 6seo � / �rC <br />ADDRESS: 019 A Jl' z 11_4 eA/ P. CMZ CITY/STATE/ZIP: , 7a c.am, P b /KA <br />PHONE (1): I'�oo PHONE2 <br />( ): /���� I -��7..G?- FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: 1 a/ Z // Time: ' cl M_ <br />(Please allow 10 business days from date of application submittal - `Te»fadve Ohly must be confirmed) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $125 FEE (C R C CK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT T _�.. DATE Z�Z <br />Electronic Information; ❑ List ❑ Map -- Description: <br />FILL: ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />street # <br />Street Name <br />i City <br />cj <br />y� <br />C7unitz <br />2. <br />—4 <br />3.a <br />�vP_ <br />"� �� <br />c P/ `j Of ;' Nonni <br />L�rS <br />C Unit 3 <br />4. <br />> <br />r fit'_ <br />L <br />t T 9r7 <br />5. <br />Unit4 <br />6. <br />U4P <br />n C�.S O ° <br />1�' <br />7. <br />^ <br />9. <br />'jotJnit 6 <br />10. <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />NDEAGROUND TANK (UST) CLEWVUP SITE (LOP) HOUSING A 3ATEMENT SOLID WASTE FACILITYNEHICLE 7 !U <br />OTHER CLEANUP SITE (NON -LOP) FOOD FACILITY ASTE TIRE I ,,, -3. <br />4UNDERGROUND TANK (MONITORINGIREMOVAL) *,DOG KENNEL DAIRY �„ 6 !� <br />HA7ARootis WASTE GENERATOR 05 0 CHICKEN RANCH ❑ WASTEWATPR TREATMENT PLANT (Z J <br />j� TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYAR4/CHEMICAL TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICA11ON SITES <br />❑ MEDICAL WASTE FACILITY ACOMPLAINT RECORDS ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 ANI-5:00PM (EXCLUDING HOLIDAYS) <br />1. List un to ton addresses in the space above. Select the types) 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 - for additional assistance with file addresses, contact the END. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant if any EHD hies 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 />3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A now application may be <br />submitted when the file is available. <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. <br />L"Wrl UU ONLY <br />EMD 4a.06 El+lvt <br />Z0/Z0 39dd ONI _1VH1N3S0d d3QN39 b06b8L69TIS 90:ET TTOZ/T0/ZT <br />