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Dnr V�D SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NQV 0 1868 East Hazelton Avenue, Stockton, CA 95205-6232 15,35 <br /> I ne: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd� <br /> ft0AR�N�11s�R�t�E PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i lG U BUSINESS/AGENCY: l_ �o Gy <br /> ADDRESS: r j)e,ve .G 43 CITY/STATEIZIP'X,0 6T9A4e± ,S f` <br /> PHONE (1): ar></—�.IY- ?3!b PHONE (2):r"q NQ.f 339j FACSIMILE S11f- 7515 k,-X <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange/aIznn��appointment date and time to review the requested records. <br /> ❑CHECK BOXTO EXPEDITE REQUEST ]�S'F (CASH O ONLY)-REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANT DATE '? -70114 <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 2• •l( if 5e2.? ❑Unit2 <br /> 3. I I`�� <br /> 4. <br /> Unita <br /> 5. 6� (3L r <br /> 6. <br /> ❑Unit 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From UfyrQ1V �/ E $ to <br /> ENVIRONMENTAL EALTH DEPARTMENT FIL S �,� Z <br /> F-1UNDERGROUNDTANK(UST)CLEANUP SITE(LOP) E]MEDICAL WASTE FACILITY _ Fe SOLID WASTE FAC//IL�ITYIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) [:]HOUSING ABATEMENT ASTE TIRE W F'yj <br /> ❑U DERGROUND TANK(MONITORING/REMOVAL ❑FOOD FACILITY AIRY �AJ I)- <br /> ❑ BOVEGROUND TANK %A, [:]CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT l <br /> [UHAZARDOUS WASTEMAZARDOUS MATERIALSON ❑MOTELIHOTEL El PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> fiTIEREO PERMITTED FACILITY(x ❑POOLISPA ❑LAND USE APPLICATION SITES ! <br /> TATTOO/BODY PIERCING oCOMPLAwTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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(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 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$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> i -IL4ru: WW 35-11Y i <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD4M6 <br /> 4128114 <br />