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RECEIVED <br /> DATE RECEIVED SAN <br /> EHD LOG NUMBER <br /> APR 14 20% SAN JOAc�UIN <br /> ENVIRONMIENTAL HEALTH DEPARTMENT X465 <br /> R HErTt� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMT/SEk2it1C`E eeiephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: BUSINESS/AGENCY: 9>GGE r fl_s(oc- f "� <br /> ADDRESS: _t� �y $ Pr;NN�? w�� CITY/STATE/ZIP: <br /> PHONE (1): Lj ry'/5�q�D�-� PHONE(2): FAX OR E-MAIL: 46 <br /> Piease allow'i0 basinese 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 REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> w EHD USE ONLY <br /> Street tl Street Name City <br /> 2. i, 1 ❑Unit 1 <br /> 3. <br /> Ly U.H z <br /> 4. <br /> ❑unit 2H <br /> 5. nit 3 V� NhI <br /> 6. 1 <br /> 53/unit 3wM <br /> 7. <br /> ❑Unit 4 <br /> S. <br /> " SITE MITIGATION <br /> 9. <br /> 10. ❑unit 6 <br /> Specific Date Range of Information Requested: From to <br /> NJENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL <br /> THER CLEANUP SITE NON-LOP ❑SOLID WASTE FACyf-jjEHICLE -^ <br /> ( ) El HOUSING ABATEMENT ❑FOOD FAGILTn' 3�-rj�I�,5 {(1i" �t.✓/�7✓✓It�' <br /> NDERGROUND TANK(MONITORING/REMOVAL)$- ❑WASTE TIRE ❑DAIRY,POOL/SPA r i Lt—(LI-/& <br /> 8OVEGROUND TANK() ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> rQ'ILin <br /> AZARDOUS WASTE IQI- ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> AZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITES <br /> TIERED PERMITTED FACILITY 'nl�OMPLAINTIRESPONSE RECORDS [:)OTHER(PLEASE SPECIFY) &Q,4P�,4.5 <br /> WELLAND 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 files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091 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 conditionasreleased 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 /> —BOXED AREA-EHD USE ONLY*" <br /> 114-11-4 �SIOb),p <br /> II 'n n n PROW.dig003 <br /> Zi <br /> 31 8 '7r 51ob a-74A0 2 ali-r IOIo�) <br /> a e. f - © (7 5 O <br /> fp�lloq`D� Slog J („v�pD3g34 �P�S I L� J tD900 IS r � LoDpO .opb5� <br /> CJDf)7IDbN pl 5106) (p��pp005V5 fppGS ) �LpppD35�i _ rQk)1 QZ- 0539��P �))qZ- 01321\�`�r � ty. <br /> ql yJ 45�Le l e�#er5)- YA <br />