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From:llarcus H. Sole & Assof yes 530+633- 0119 05. 12012 10:22 X239 P,001 <br /> I <br /> DAT E VZ6 EHD LOG NUMBERz 4 SAN JOAQUIN COUNTY Vim, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0 II'k 600 East Main Strut, Stockton, CA 95202-3029 �y <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> 4111-1 <br /> �IttMV <br /> CF� SLI L[ ELEASE APPLICATION <br /> APPLICANT: l tX i3USlPdESS1AGElCY: �� �0 � <br /> ADDRESS: }} ✓ ppCity/Stately ip 1r d C tl7 pyu <br /> PHOtdE 0 t� p� FACSIMILE: 4� <br /> TENTATIVE*APPOINTMENT DATE:f20AIJ Time: <br /> {Please allow 16 business days from data of application submittal I*Tentative only-must be confirmed} <br /> ® CHECK BOX TO EXPEDITE REQU T•$105 FEE CAS OR CHECK ONLY)-REQUEST PROCESSED IN 3 8 SINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE <br /> I <br /> loctrortic Inforrrtation: ❑ Llst�] Map--Description: <br /> FILE ADDRESS _ EHD USE ONLY � <br /> �— Street# —® Street Name City / <br /> ❑ Unit � <br /> 2. El unit 2 <br /> 4. l CO Unit 3 <br /> Oi�y�� ...._�� �{ Unit 4 <br /> ❑7. <br /> Unit 5 <br /> 8, <br /> 9. <br /> �.`z�` ®� unit 6 , <br /> 10. <br /> Specific Date Range of Information Requested:From ° _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK{UST}CLEANUP SITE{LOP} (O HOUSING ABATEMENT SOLID WASTE FACILITY[VEHlCLE <br /> OTHER CLEANUP SITE{NON-LOP} 0 FOOD FACILITY WASTE TIRE <br /> UNOERGROUND TAh3K{MONITORING/RemOVAL) 71 DOG KENNEL 10 DAIRY <br /> HAXARDOUSW ,TE GENERATOR (1 CHICKEN RANCH �WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTELII IOTEL ®PUMPER TRUCKIYARDICHEM TOILETS <br /> CO TATTOOIBODY PIERCING 0 POOL/SPA El No USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY IF OTHER{PLEASE SPECIFY} I / y's Lg <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-MONDAY-FRIDAY 8:00 Am- .'004 . 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 2091.464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD. 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 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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new 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$105 deposit prior to review. <br /> EHD LIS ONLY <br /> Y1€ � I r r _ 2r�1/ r tL`ri� ' Gi G7 t >tJ?r_; `•_s <br /> � P Sf l's,/I/;}�".�•.Q�,��:�-�.7 7/c�,� ._..,�`�t`�i{�'��/r�/A''1 �•� rrUi�'E� � �'��-�J����^t`` �%Ir-�'ft�� _ r7�' <br /> iPUBLIC RECORDS RELEASE APP FORM <br /> EHD z 8-06 8/04/08 <br />