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A lV E EMD LOG NUMBER <br /> G V G, SAN TAL H A COUNTY <br /> MAY 0 9 2012 ENVIRONMENTAL FIELTH DEPARTMENT <br /> 600 East Main St. Stockton,CA 95202-3029 <br /> Telephone: (209)4683420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ENVIRONMENTALHEALTH <br /> pICES PUBLIC R CORDS RELEASE APPLICATION APPLICANT: _711^1111 <br /> 1 t � BUSINESS/AGENCY: O d 1 L n v.r v n M <br /> � <br /> ADDRESS: 1S. 1L i K\A\f e N� V`fl ]OE IS 1.0 CITY/STATEIZIP: C k I b <br /> PHONE(1): 0x1-'1S0-0cA0 PHONE(2): FACSIMILE: 71� J71T�'nrQS <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Plane allow 10 business days I to of application submittal-'TentatAre only-must be confirmed) <br /> ❑CHECK 60X TO EXPEDITE REQU -$122 F ( H QR/CHECK ONLY-REQUEST PROCESSED IN 3 BU (NESS DAYS <br /> SIGNATURE OF APPLICANT ir�� DATE S ���lZ-} <br /> Electronic Information: ❑ List❑Map-•Description: <br /> FILEADDRIES5 EHD USE ONLY <br /> Street# Street Name City ria 1 <br /> 1. t <br /> Z. c D NO UnK 2 <br /> 3. <br /> 4. Urut3 <br /> 5. ***Please respond as soon as possible. <br /> 5. I need to notify applicant during week of 5/14/12 if plea <br /> T. EHD has files for listed addresses or not. <br /> 8. ❑Units <br /> 9. <br /> 10- Unk6 1 <br /> Spaeiflc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES '1 ]/ <br /> NDEROROUNU TANK(UST)CLEANUP SITE(LOP) ❑HWSING ABATEMENT SODDWA$IE FgCILRYNEMCLE 4 <br /> HER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTEPRE �(,�I 3 •r'-� <br /> NOERGROUND TANK ONITORINGIREMOVAL OC ❑DOG KENNEL DAIRY <br /> RDOUSWASTE GENERATOR OC ) ❑CHICKEN RANCH WASTEWATERTREATMENT PLANT 5-I <br /> IEREOPERMITTED FACILRY(� ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARNCHEMICAL TOILETS <br /> TATTOOIBODY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SUES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(ExCW DING 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(209IA64-0138 or mall to the address indleated 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 appointmentfor 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 applicatlon 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$122 deposit prior to review. <br /> C EHD USE ONLY <br /> (J y/ 1 t <br /> � 55► rip <br /> EN <br /> J <br /> eHene-se a 07125110 (��� <br />