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01/0011///20010 01:07 2093398382 MIDCAL INDUSTRIAL PAGE 01/01 <br /> ' RECEIVED EHD LOG NUMBER <br /> PATE RECEIVED SAN JOAQUIN COUNTY <br /> �.' AUG 26 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> LNMRONMENTALH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT/SERVICE�elephone: (209) 468-3420 Fax: (209)464-0138 Web:wvvw.sjgcv.org/ehd <br /> PU13LIC'REC/O�RDS RELEASE APPLICATION <br /> APPLICANT:'r p BUSINESS/AGENCY: RSL Fsr <br /> ADDRESS: 4 4N,` %K/M/ fI'CW)( CITYISTATE�/76IP: SW-, 7-!W Q''9Z�y9�����/�� <br /> PHONE(1): PHONE(2): I_ <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 /> []CHECK BOX TO EXPEDITE REQUEST- e (CA O HECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE, <br /> Electronic Information: ❑ List❑Map—Description. <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name city Unit 1 <br /> 1. eFeO C)MIecy .57-m�ro-W v I� t^�p h �IUSZ—cA <br /> unit z <br /> 4. i DC� v 1 Ir/, �C i .2. /. fl Unita <br /> g. Unit 4 <br /> 7. <br /> C1- 5 s`s12 Ih! <br /> 9, <br /> 70. ❑Un@ 6 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASrE FACILITY ❑SOLID WASTE FACILNYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> FVINDERGROUND TANK(MONITORINGIREMOVAL) C1 FOOD FACILITY ❑DAIRY <br /> rR <br /> �E��n,r,,�BO�V"EGROUND TANK L]CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> I7,d467ARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL C-]PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACWT! El OOLISPA E]LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING COMPLAINTIRESPONSE RECORDS, ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAIL BLE FOR REVIEW: MONDAY-FRIDAY 8:00 AIV-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 /> 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 pre 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 number 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'""' <br /> J VA n 1 UU L'I C t O 0A Lo 1�0 b <br /> t9v� 1. r <br /> ❑ Records provided by Staff-PPR Complete, Staff Name: <br /> ENO 48.06 08101114 <br /> Received Ti<Aug. 25. 2015 7: 55PM No. 9420 <br />