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EHD LOG NUMBER <br /> Dqr EryED F J SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 9 <br /> ITEC 2 5 20115 1868 East Hazelton Avenue, Stockton, CA 95205-6232IJ <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgovC. <br /> .orglehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:YJ�I V MECt\vAyN1b BUSINESS/AGENCY: �' �k ,R hSSOc\R(I S, )1�G. <br /> CI I TISTATEIZIP: N Mee ��\C <br /> ADDRESS: P.O b1C 3 FAX OR E-MAIL: YO(,WA b'LURASS��FA S• <br /> PHONE(1): \\➢' )C �' PHONE (2): <br /> U0111 date of application submittal <br /> Please allow 10 business days for the records to be available. tOW� <br /> Staff will contact you to arran a an appointment date and time to review the requested records. <br /> ElCHECK BOX TO EXPEDITE RE UES - 130 FEE AS OR G CK REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT ' <br /> Electronic Information: ❑ List[](Map–Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street TF <br /> Street Name City <br /> 1 32�� LGCM\S X17 S�O��tON � � , n ❑Unit a <br /> 2. ticp0� S �\Ny a% OL ki J/ �Unit2 <br /> 3. 3233 1 o0b\\S 4 D SToCTbN t(, <br /> /� S N 1� y%°I ��-oNSN R-� STo(, "CbNUnit 2H <br /> 4. N <br /> ��2 1 !� nit3 4)1101 <br /> s. 201 S y 11 <br /> ( 6. 'j\\2 \A\A\ F'� S��Uf���IV IY (./�� Unit 3HM <br /> 7. ('\2-1 S 14� �� () A) �1 TE TION <br /> B° 2c��c \ DOM15 '�D <br /> 9. ❑Unit s <br /> 10. <br /> to /.�J.(�"r <br /> Specific Date Range of Information Requested: From t r <br /> rrryyy��� ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILIN( VES � .14 <br /> yrt <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTEUHOTEL ❑FOOD FACILITY ,I <br /> ZI OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑DAIRY,POOLISPA I(O <br /> UNDERGROUND TANK(MONITORING/REMOVAL)O( ❑WASTEN RE <br /> ABOVEGROUND TANK O( L]CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE O( ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> MATERIALS ❑TATTOOIBODY PIERCING E]LAND USE APPLICATION SITES <br /> HAZARDOUS MATER <br /> ®TIERED PERMITTED IALS TY(X COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> FACIWELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM EXCLUDING HOLIDAYS) <br /> 1. List un to ten addresses in the space above. Select the types)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!f any EHD files exisE An appointment far review v✓!!I be firmed approximately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days Tor review. Appointments <br /> should be scheduled accordingly. <br /> expense of the applicant. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. <br /> ""BOXED AREA-EHD USE ONLY— <br /> btoo4mi S : co 3946 <br /> 3 t'y <br />