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mar u Cuia C; jurn oa51u5 Cnvirunmrn�aij inu otuoo-rouoo r.. i <br /> ■� 1v'EE 9 . •, � EHD LOG NUMBER <br /> :o`�._w EI ,, 6 SAN JOAQUIN COUNTY <br /> 'r MAR o 2015 ENVIRONMENTAL HEALTH DEPARTMENT 1A� <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 v <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: WWW.sjgov.crglehd <br /> ENUIRCNM EN TAL HEALTH <br /> PERNIMSE11VIICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: L-� BUSINESSIAGENCY: 00.5 C,5 T__AVMOnrnerLt , err. <br /> ADDRESS: (� 5 IZ.4� J�F(�p�- S�i�e 116 CITYISTATE/ZIP: Cn V iu4 CA �H 60 T <br /> PHONE (1): X510) PHONE (2): (510 � Ll�-`180 FACSIMILE:(Slo) 839- 90` ? <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contactyou to arrange an appointment date and time to ravlewthe requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$];0;EE(CASH 0 ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3Z'�l I S <br /> Electronic Irtforma(ion: ❑ List ❑ Map—Description; <br /> FILE ADDRESS EHD USE ONLY <br /> streettf Street Mama city Unit <br /> ,. (9 Vj e 5 Qft e S�bLiC� r„M �✓ 57 <br /> Unit 2 <br /> 3. yy <br /> 4. lintt 3 <br /> 7. ,;� <br /> Unit 5 <br /> 8. <br /> 10, 0 Unit e <br /> Specific Date RanOoofInformation Requested: From I`i 0 to !'CSCAk <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) []MEDICAL WASTI FACILITY ❑SOUD WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUMOABATEMENT ❑WASTETISE <br /> UNDERGROUND TANK(MDNITORINCIRENovAL) [I FOOD FACILITY DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/Doo KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPERTRUCKIYARD/CHEMCAL.TOILETS <br /> ❑TIERED PERYETTED FACILITY ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑TATTOOISODYPIERCING ❑COMPLAINTIRESPONSERECORDS ❑OTHER(PLEASESPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AN-5:DOPM (EXCLUDING HOLIDAYS) <br /> 1. List up to tan addresses In the space above. Select the typ (s)of flies from the list above by checking the appropriate <br /> box(**), At least one flis type MUST be selected. Fax to(209)464-0138 or mall to the addrses indkated above Address <br /> ranges will net be accepted.Applications received after 3:00 pm will be procassed the next business day. <br /> 2. For assistance In Identifying the nature and content of EHD records, please contact END at the number noted above. <br /> 3. The EHD will notify the applicant If tiny EHD files exist. An appointment for revlew will be confirmed approximately ton(10) <br /> days after recslpt of appIICatlon. The flies 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 filo reviews by the same applicant may require a$130 daposlt prior to review. ”"BOXED AREA-ENO USE ONLY"' . <br /> ❑ Records provided by Staff-PPR Complete. staff Noma: <br /> ErRece ved Time-Ma r, 4, '2015'10 0. 8262 VI0 eB <br />