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r v DATE RECEIVED-t EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> [IES I G ZQi� <br /> 1- ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 V:0040 <br /> C <br /> /{( _ Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: vw�w.sjgov.org/ehd <br /> F^�"AD.. itI I <br /> -� :�':F:f,' "r:.•;'" c PUBLIC RECCORDS, RELEASE APPLICATION <br /> APPLICANT: "JCCIjG_�li2/ BUSINESS/AGENCY: <br /> ADDRESS: 2?2a i j aovd �, CITY/STATE/ZIP: CL�107ulh11-f I-W <br /> PHONE (1): zlo PHONE (2):2)l _Z12_633Z FAX OR EdtgAIL:JGry�4d/ei' <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 R EST-5130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE fy_ <br /> Eiectronic information: [✓7 List Eli0ap—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> 841_1 � L'' tic l,U7t� 3c , 5, <br /> ❑ Unit 1 <br /> 2. 7 E AQAJO aw'r <br /> 3. �Init 2 <br /> 4. <br /> El Unit 2H L <br /> 5. ® Unit 3 <br /> 6. nit 3HM <br /> 7. 'n,t 4 <br /> 8. ❑SITE MITIGATION <br /> 4190 <br /> [Ujnit5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 101UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL SOLID WASTE FACILITYNEHICLE f <br /> F-1OTHER CLEANUP SITE(NON-LOP) ElHOUSING ABATEMENT El )FOOD FACILITY 1 �j!/Wt 3 <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑',`VrASTE TIRE ❑DAIRY,POOLISPA <br /> ABOVEGROUND TANK IJ' ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMLNTPLANT <br /> M/h'AZARDOUS WASTEvC ❑MEDICAL WASTE FACILITY ❑PUMPER T RUCKfYARDICHEMICAL TOILETS <br /> T2/HAZARDOUS MATERIALS ❑TATTOOIBODY PIERCING VLAND USE APPLICATION SITES <br /> ❑TIERED PERMITTED FACILITY kCOMPLAINTIRESPONSE 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(209)464-0138 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 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. <br /> ***BOXED AREA -EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br />