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g D, CEIVED" SAN JOAQUIN COUNTY No. 0139 EH P. 1 NUMBER <br /> I% <br /> iN APR 0 9 2015 ENVIRONMENTAL HEALTH DEPARTtVICNT <br /> 1868 East Hazelton Avenue, Stockton, CA 96205-6232 <br /> ENVIRONMENTALH&W hone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Av L'3 BUSINESS/AGENCY: ►d'J `� ✓a'ruti�'Q " <br /> ADDRESS: I S-33 8-- CITY/STATEIZIP: <br /> PHONE (1): S IO•-2g7' `W__0O�PHONE.(2): FACSIMILE: S'`l0-�° (, 71 <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 /> ❑ <br /> CHECK BOX TO EXPEDITE REQUEST-$t 3 ESITOR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l DATE. <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name City ❑Unit 1 <br /> 2. �— 'T r .ID unit 2 1 r <br /> 3. 0 0 mac. <br /> 4- 0 ST F3 Unit 3 <br /> S. <br /> A <br /> 6. ,p Unit 4 <br /> 6L.4 <br /> 8. \Ln ❑u„Its <br /> 10. L]'Unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNELIUASTEWATERTREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS.MATERIALS Q MOTELIHOTEL ❑PUMPERTRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING 'XCOMPLAINTIRESPONsE 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 (2091464-0138 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 numbar 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 °x <br /> f lkek MTri(e 'r foo K'*0 f1'q^ QI~ v`tA CD. <br /> 11 Records provided by,.Staff-PPR C_omblete. Staff Name: <br /> Received Time=Apr. 9., 2015= 3 ;.1-7PM=No A496 08,81114 <br /> env ao-vo -"' <br />