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/06/2015 1 : 19 : 07 PM —0406 FAXCOM ANYWHERE PAGE 2 OF 2 <br /> DATE RECE VED EHD LOG NUMBER <br /> ,-� � SAN .IOAQUIN COUNTY <br /> \C1 -� / ENVIRONMENTAL HEALTH DEPARTMENT k` <br /> ' go S <br /> 1 ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> L✓ ok o• / PUBLIC RECORDS RELEASE APPLICATION <br /> I <br /> APPLICANT: O <br /> �C' � y, BUSINESS/AGENCY: 1 1 / 'e";'roAmeA'I �nL <br /> ADDRESS: 3 /I� ��As R� 5 ,���f� CITY/STATE/ZIP: R- ; I I er 6 A <br /> v ) <br /> PHONE(1): �Ib.9 �lS. 3�» PHONEL_ FACSIMILE:_;K:�-_ _fff(_:�Z�.7S <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQU T-$730 F E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU (NESS DAYS <br /> SIGNATURE OF APPLICANT DATE S <br /> Electronic Information: ❑ List ff Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city _ ❑Unit 1__ <br /> T ._ .. __..._... <br /> 3 bo " <br /> 2. LO.V........__ c to �+ti t 1"^M W ....rygl-��h LF.d ❑Unit2 <br /> 0 � 3. Zi t <br /> 4' _ _1E3 Unit <br /> 6. -pn"��(�; ti a I(A�/ <br /> I _0 Unit 4 <br /> 7. �v✓1 <br /> ti <br /> Units <br /> 9. <br /> 10.Unit <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> JA2ARDOUS <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY OLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE(NON-LOP) ElHOUSINGABATEMENT WASTE TIRE <br /> DERGROUND TANK(MDNITORINGiREMOVAL) El FOOD FACILITY ❑DAIRY <br /> OVEGROUND TANK E]CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> WASTEIHAZARDOUS MATER[AS ❑MOTELIHDTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> RED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of ales from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0138 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. "*BOXED AREA-EHD USE ONLY*** <br /> n0%;'1R). �7 '1 (v! 'WW ^4 '546 N)c co . <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 08/01114 <br /> Received Time May. 6, 2015 10 : 19AM No. 8638 <br />