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EIVED `� <br /> DATE Y EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 14 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIR0NMENfM_1+19A0t119: (?09)-468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PERM)T/SERVICES Fa <br /> PUBLIC RECORDS RELEASE APPLICATION " <br /> APPLICANT: VA U L_ 'ukrC wLI BUSINESS/AGENCY: f <br /> ADDRESS: S$-00 G LJ�}S�J )`C L P0 CITY/STATE/ZIP: S(:i CC_1 6A/ C/� rj�oZl4 <br /> PHONE (1): )b6 — y S a oZ sPO PHONE(2): R o, -6MR-6 6 z FACSIMILE- <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be confirmed) <br /> X\ C <br /> HECKBOX TO EXPEDITE REQU T-$125 FE SH ORCHECKONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIURE OF APPLICANT DATE_ <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City S <br /> it 1 <br /> 1 1 3 N f=LAa C I Til 610) L 0 be cp-9� 4L <br /> 2. 4, ❑ Unit 2 <br /> 3. <br /> 5. <br /> S. 0'Unit4 <br /> 7. r ? <br /> 8. C <br /> ❑Unit 5 <br /> 9. �A <br /> 10. <br /> ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WAsTETIRE SCA'k qj <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) ®FOOD FACILITY .❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT' <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> M TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES _ <br /> F]TATTOOBODY PIERCING COMPLAINTIRESPONSE RECORDS ,) OTHER(PLEASE SPECIFY) VJ6t l'. (,,4?-),l� <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-17RIDAY8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate ?rA <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.for additional assistance with file addresses,contact the EHD. Applications received after T" <br /> 3:00 pm will be processed.the next business day. f <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for reviewwill be confirmed approximately ten(10) y'Frj <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. n Fr <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 /> 3 -1 PMV <br /> CODU o ') X S - (DI e r �1 <br /> a15 Sm5 A COCO )OFSO <br /> ❑ Records prov)ded by Staff-PPR Complete. staff Name: <br /> EHD 46-06 <br /> 914112 <br />