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------------ <br /> RIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> APR 2 4-2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTALHETALPI"hone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> PERMITISERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION' <br /> APPLICANT: S I�A� •�J BUSINESS/AGENCY: <br /> ADDRESS: y�pL�4�tL. ��„ PL CITY/STATE/ZIP: �,q {�„e CA 9,)w) <br /> PHONE(1): `ll�.�'�1���(Ja PHONE(2): Q��- ro'S" (�FACSIMILE: QN9.-6&j.�-_4>1jj,( <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tenfative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE R ES -$125 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map- escription: <br /> FILE ADDRESS EHD USE ONLY <br /> r <br /> street# e- Street Name City Unit 1, <br /> T 0 U/li 3JJ/5 <br /> 2- <br /> 0 Unit 2 <br /> Z 3. <br /> 0' 4. ,❑Unit 3 <br /> 5. + <br /> S 7. [aCit4 <br /> �. 8. <br /> 9 Units <br /> .0 10. - <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From <br /> to <br /> �,,������JJJJJJ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOUD WASTE FACILDYN HICLE`_ 'I _ <br /> IR-I THER CLEANUP SITE(NON-LOP) L HOUSING ABATEMENT ❑WASTETIRE y -��PS[[)/' W l/ 3 <br /> L"�UNDERGROUND TANK(MONITORING/REMOVAL) E]FOOD FACILITY ❑DAIRYF`1 4 <br /> ❑680VEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL � <br /> AZARDOUS WASTE/HAZARDOUs MATERIALS K ❑WASTEWATER TREATMENT PLANT <br /> ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> > ❑TIERED PERMITTED FACILITY ❑Q,e01JSPA ❑LAND USEAPPLICATION SITES <br /> ❑TATTOO/BODY PIERCING Q'COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> 5 WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM-(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 1209)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$125 deposit prior to review_ "'BOXED AREA-EHD USE ONLY" <br /> 14' e <br /> L-/Tc <br /> -2' N • ecv F5 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4a-05 <br /> 910n1 <br />