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RECENED <br /> DATE RECEIVED fis <br /> '�pp SAN.�OAQUIN COUNTY EHD LOG NUMBER <br /> MAY 2 � P.0lii"r ENVIRONMENTAL HEALTH DEPARTMINVA <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www,sjgov.org/ehd <br /> pERf&lT1SERMC-EIr PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: AA) 7 LE S'j J BUSINESS/AGENCY:-AN6_gil-i\J 19 CAQiJFLC— 4a1-t0 <br /> ADDRESS: 4-(� �i /1,�_()C),<}'a k' K L1,/F ;( /I'1 F- 1.. j() CITY/STATE/ZIP: _C A <br /> PHONE(1): �E (� �C�S `ate 4 1 PHONE(2): �SR— � '� -nrJ/� FAX OR E-MAIL: -1, - -L i.( ism J r�I�v l:/• .C o w <br /> vi <br /> Please allow 10 Business days from date of ap�ion submittal for the records to be available. t1 <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ER CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE S12� 12-0 14 <br /> 1. List uo to ten addresses in the space below. Select the type(s)of files from the list below 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 /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From to � <br /> ENVIRONMENTAL --- 01t le-61 ,, <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> l�UNDERGROUND TANK(UST) Street# Street Name city <br /> �YTI'CLEANUP SITE(LOP) pn A 1, 4 ,)` ki�' 61JA.,IJJW <br /> CONSUMER <br /> M OTHER CLEANUP SITE(NON-LOP) ' 1913�3 M ►{ms`s R "�-� S i�C__M N ,�' 1 C11w.j HAZARDOU <br /> WASTE <br /> �I '��'VJ <br /> TIERED PERMITTED FACILITY ✓�UYNfrl! Tv-V <br /> ABOVEGROUND TANK � <br /> [�UNNY <br /> UST (MONITORING/REMOVAL) t /"J []PWS <br /> '1101 HAZARDOUS MATERIALS ' C M�1 ��✓� '^-"�AD <br /> SPILURELEASE RESPONSE <br /> Y' U ®WATER QUALITY <br /> SOLID WASTE FACILITY/VEHI L 4 I� '-I posh <br /> ❑FOOD FACILITY 1 , <br /> POOL/SPA SITE MITIGATION <br /> 5 <br /> DAIRY L �w�/ N... <br /> L]LAND USE APPLICATION SITES <br /> .�t fLj ,I 'HOUSING <br /> SEPTIC PUMPER TRUCK/ B G ^^ �^ �i �N� <br /> YARD/CHEMICAL TOILETS (yam `j(��,-/, _/ <br /> ❑WASTEWATER TREATMENT PLANT / K Pi/r j' ✓ /L/L.0 I ®CJPA <br /> ❑HOUSING ABATEMENT T 9� 1 / ©0 A 1' /�,� /l,r� S�,yi•y.�.l �� ��L�� �l <br /> 7 MOTEUHOTEL O� (7 (� /VL u�c,'/I� II <br /> -HA2-MAT 7 CHICKEN RANCH/DOG KENNEL ()Z,,) 14 1�� PA <br /> S <br /> 7 MEDICAL WASTEFACILITY <br /> O TATTOO/BODY PIERCING Cl SOLID WASTE <br /> ❑WASTE TIRE g <br /> COMPLAINTIr <br /> !�'gyp�"�� /� <br /> OTHER(PLEASE SPECIFY): jat {, 01IZ5 �''�/i5 (A 13 � <br /> 11 wll 'CffU <br /> 'D T <br /> —BOXED AREA-EHD USE ONLY- <br /> 7,7 LIAJA le "l _�3 /0041,1 a25k__ n ,V� <br /> tiles P j 4Z Cie <br /> 11 4,mqq. !;' �'7 . FJ i4W 6 i 46 ar,0 ) <br /> D b Staff-PPR tem <br /> EHD 48.08 w 1 ,6 roIr &4-y—' 1 n �'Y�2 h-r A_ e fV- d Nlo q mw►-,ri d <br /> z4'5/M 60,465" - <br />