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U1/10/GUUy 1D:D4 rAA OOL <br /> DATE RECE17 {L1J� EHD LOG NUMBER <br /> I r'' r v SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 0 <br /> J - i Z00 Telephone: (209)468-3420 Fax: (209)464-0138 Web: wWW.sjgov.org <br /> `iif�wtw7 <br /> EI�Vir��JP•�h�EivT ��EA��H (((��� <br /> PUBLIC (RECORDS RELEASE APPLICATION _ <br /> APPLICANT: Y 1- 4k BUSINESS/AGENCY: M& ^ U <br /> ADDRESS: ��1 - I (DWA,N City/State/Zip 10-VINe ,J <br /> I. <br /> PHONE(1): q40-UBI - 12 PHONE(2); q�y.3g4-Vt>6 ��FACSIMILE: 9!V1-2So"lll1� <br /> TENTATIVE*APPOINTMENT DATE: '7-21-D 9 Time: -I ph <br /> (Please allow 10 business days from date of application submittal- Tentative only-must be Confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7—/1,-jA <br /> Electronic information: ❑List[]Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City ❑ <br /> nit 1 <br /> 1 5' W. o t!Y(a <br /> -A In IAI-511r- fe Ell <br /> 2' 22 t�r1i e& ❑ Unit 2 <br /> 4. 3 ar n CAW It <br /> 3 c tjii :a un i ° J <br /> I q W t <br /> 6. _"Z!;$r6.jt 4 <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 1 I]. <br /> Specific Date Range of Information Requested: From _ Jh G yD »M to _ pr(XtAt . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES Q /= <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C!HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE rJ r <br /> UNDERGROUND TANK(MONITORINGIRPMOVAL)6, la DOG KENNEL 13 DAIRY VL/I ryryry��� <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH C7 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACWTYD�' 0 MOTELfHOTEL Q PUMPER TRUCKIYARDICHEM TOILETS <br /> C7 TATTOo1BODY PIERCING 0 POOLJSPA 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY B: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 209 464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <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 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 /> 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 /> 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> ,n <br /> �• y N <br /> EHD 48-06 8104/08 PUBLIC RECORDS RELEASE APP FORM <br />