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DATE RECEIVED EHD LOG NUMBER <br /> (uJ I (� '_j���L SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUP! 0 1008 600 East Main Street, Stockton, CA 95202-3029 F 7 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: WWW.sjgov.org! j� <br /> .•VI �C� ' � 'r. <br /> Eta/IRi)iVttl P i nEF;L; PUBLIC RECORDS RELEASE APPLICATION <br /> RAI I^ <br /> APPLICANT: c yy BUSINESSIAGENCY: �L+or s� <br /> ADDRESS: �L�LI I IarL/•'A; Ayt S,,,jc L LA `)rigL <br /> PHONE(1); Ilk 148b-OuL_131 PHONE(2): FACSIMILE: e11ti 14gr2 - (76O--� <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Pima allow Un business days from date of application submittal-•Tentrfive only-must be confirmed) <br /> O CHECK BOX TO EXPEDITE REQU T-{88 s,0 E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 15- -T-M? <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Strom 0 l I 1 Strom Nam .1y City O Until <br /> - H 1 -r� V(- IGGLL '../ <br /> 2- S6 -u 1A) � � �' All InoC_O/ZP OUnit 2 <br /> 3• 235 1 (3rc�z�w o Ne db P <br /> \� a0 - 5 � (ems NoroisP ht- <br /> `o L . - L _ 5 F-57ar P <br /> 8• o lints <br /> 9. <br /> 10. ❑lion s <br /> Specific Data Range of Information Requested:From .. I��� to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> DNOERGROUNO TANK(UST)CLEANUP SITE(LOP) 0 HOU81H0 ABATEMENT 171 SOLID WASTE FACILITYNFJaCLE ^ <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY13 WASTE TRE LL�'/rL l0�18/0'F <br /> C UNDEROROUNn TANK(MONITOmuWREMOVAL) X ❑Coo KENNEL ❑DAIRY I �� r <br /> HAZARDOUS WASTE DENERATOR 13EW <br /> OCHICKEN RANCH WASTEWATER TREATMENT PUNT o UMn1 <br /> TIERED PERMITTED FACILITY O MOTEL/HOTEL ❑PUM PFR TRUCKNARDICHEM TOILETS <br /> TATTOOIBODV PIERLWG O POOUSPA ❑LAND USE APPLK:ATION SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AvIuFABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM.5:eDPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the typs(s)of Hles from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-013$or mall to the above address. Address ranges will <br /> not be accepted-for additional assistance with III addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 ton <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 /> a. A file that is actively heing worked on by the EHD staff may not be Immediately available for review. A new application <br /> may be 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$98.00 deposit prior to review. <br /> EHD YSE ONLY <br /> (� <br /> MD4 IOntpf PUBLIC eE OROS RELEASE APP FORM <br /> Loo/L009 Xvd 9Z:171. BOOZ/60/90 <br />