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RECEIVED <br /> SANJOQQUIN JAN 10 204,e E_nyironmental Health Department <br /> • —COUNTY k���l PUBLIC RECORDS RELEASE APPLICATION <br /> EMIRONri,ALLWAd <br /> PEfWrr/5ERVM9 EHD LOG NUMBER: 6 7000 <br /> APPLICANT: hnL1_ N(nlerzl- _ BUSfNESS/AGENCY: VJallctcc -kohl , Prune. <br /> ADDRESS: � 5 Lrvia;lyt,.d PSUrI .. - CITYISTATEIZIP: \!Jest ,Ct���..��> CA °1t-1.q I <br /> PHONE(1): qlt,- .3�.0- 143,1 PHONE(2): FAX ORE-MAIL: nmalnra} tautrTllara-1�.,hl.u,rn <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact ou to arrange an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT ,.apQ.yf/i[!nlf;L DATE I�lulaytX <br /> 1. List up to ten addresses in the sp a below. Address ranges WILL NOT be accepted. Select the ty e(s of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464.0138,mail to the <br /> address indicated below,or email to Infona.sicehd.com. Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted below. <br /> 3. The EHD will notify the applicant if any EHD fifes 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. I �- <br /> Future file reviews by the same applicant may require a$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5;00PM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name City ^ <br /> u( Cleanup SHB(LOP) �I p I Cona..En <br /> ®Other Cleanup Sim(Non�LOP) \ Syo3 S. A.rrc/t' WNq '� <br /> ®Hazardous Waste ua, I t <br /> ❑neredAbove Permitted Facility 2 5y,q C A,Ir�,Yt WLW S}�(.��CYT �I�'-r-50-1 u-3) �Tt1.r <br /> ®Aboveground Tank J I 1 1..+•Jfl t � <br /> ®UST (Monitoring I Removal) r, Y HM'N1ty.N (,Q &nfd&X Its <br /> ir1/'lf_�yY� <br /> ®Hazardous Materials a (p11 S. )t\;Y- t We'-ii rE S7c f 1's <br /> Spill I Release Response <br /> Solid Waste Facility/Vehicle q 41� { �`t'ALF, <br /> Food Facility <br /> Sic« k. r. , <br /> ❑Pool I spa �(J Sire Mnlnnnon <br /> Dairy a - O al i1 , <br /> Land Use Application Sites t <br /> ❑Septic Pumper Truck/ a �- 'r t-Tln Y:J ❑Housing <br /> S G'�rvue o� fs <br /> Yard/Chemical Toilets � <br /> Wastewater Treatment Plan[ t(�� CUPA <br /> E]Housing Abatement r � ` AST/HMIHW <br /> ❑MotelMotelMrUPA <br /> n I G <br /> Chicken Ranch/Dog Kennel S -I C tom,,r- S Vr p OUST <br /> Medical Waste Facility ' V l l/ <br /> ❑Talloo/Body Piercing Souo WMs <br /> ❑Waste Tire g <br /> Complaint <br /> Other(Please Specity): D AccouIrr. <br /> 10 <br /> "'BOXED AREA-EHD USE ONLY" <br /> t- leL1.141f'e reLZ'&k 4 PX0 z , H G^k We., OoV- Pg- <br /> 0 Records provided by Staff-PPR Complete. staff Name: EHD4o-ae <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />