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DATE RECEIVE SM 'ON Wdo etoZ 'l 'ADN am p0A1a:a8 <br /> SAN JOAQUIN COUNTY CHU L b ryUMtlGK <br /> ENviRONMENTAL HEALTH DEPARTMENT <br /> X0)3 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENTNLtiMTH <br /> P \ PUBLIC RI=C®Rfs$ RELEASE APPLICATION <br /> APPLICANT: '� C,t 4 ( h(�t✓yy �(91' � EIUSINESS/AGENCY: <br /> ADDRESS: �a q ) (,L.YY a r kt C. O / CITY/STATEiZIP:� QQ A-.Pj r/9' y910)3 <br /> PHONE(1): yl ?)4- S-I PHONE(2): FACSIMILE:y',�- u-19- W <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-•Tentodve only-must be Confirmed) <br /> ❑CHECK BOX TO EXPEDITE RE ST-$125 FEF(CASH OR CHECK QNLY)-RECIVEST PROCESSED IN 3 BUSINESS DAYS . <br /> SIGNATURE OF APPLICANT [�/Gl�j//� '�-�\J DATE _ 3La a �3 <br /> Electronic Information: ❑ List❑ )Aap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street Street Name City a Unit <br /> tel) os;' 0b j- <br /> 2. D�#TQ <br /> i3' Unit2 <br /> �OL-Ll <br /> )� a, a /n e i <br /> V $' 3480 ►!n4«IP .,y- , Noco/ <br /> Figo <br /> . l7V ✓1 (.L)OU\CQ Kl2 U j \�ci i ZI'I p�Unite <br /> Specific Date Range of Information Requested: From to <br /> IOUUUNDERGROUND <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITY]YEHICLE/THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE }T /j,)La6 '9//'TANK(MONITORiNGIREMOVAL)Q` ❑FOOD FACILITY ❑DAIRY v ( �/`I71(- 1+13 <br /> ABOVEGROUND TANK CHICKEN RANCHI DOG KENNEL �"— <br /> ❑ ❑WASTEVdATERTREATtEEN PLANT <br /> HAZARDOUSWASTEII�RDOUSMATERIALSPA, ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOLISPA E]LAND USE APPLICATION SITES <br /> [jTATTOOIRODY PIERCING '❑JK COMPLAINTIRESPONSE RECORDS OTHER(PLEASE SPECIFY)\A/e)'� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE:FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:0013M(EXCLUDING HOLIDAYS) <br /> f. List up to ten addresses in the space above. Select the type(s)of files ham the list above by checking the appropriate <br /> box(es)- At least one file type MUST be selected. Fax to(2091464.0133 or mail W the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Appilcali®ns received atter <br /> 3:00 pm will be processed the next business day. y:,' it <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days atter receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <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 /> A. 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. "BOY.ED AREA-dHD USE ONLY <br /> MPl. Z <br /> v-? Records pa' vided by Staa1:-PI?v Comgplette. slaivName: <br /> 9ihl",T. <br /> Td WdgZ:TO £TOZ- TO 'AON 886£6LPSTV 'ON Xyd NUW3NNUA IGOf WO21 <br />