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ucr lot cuO� li.❑a int Da rOGIrJ7 bLHI,KbUKN GUNbULIMU YHUt bl <br /> EHD 1.00 NUMBER <br /> I�PNED SAN JOAQUIN COUNTY <br /> S ` v ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 q 36 <br /> FEB3 ZOOTelephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sigov.org/eh <br /> WIPO,)NNIENT HEALTH <br /> }Y�c :R\llCES PUBLIC RECORDS RELEASE APPLICATION ,7 1�., <br /> APPLICANT: _ BUSINESS/AGENCY: 01-MC,<KI,[e_A1 loo�47?W61 <br /> r <br /> ADDRESS �n • �- SrR�t� Citylstate2lp �A/Cc-r {gcpAmxalTD CA 9sb91 <br /> : �. <br /> PHONE(1): aJ _Z,S - R7U G7 PHONE(2): - _ FACSIMILE: - 7 <br /> TENTATIVE'APPOINTMENT DATE �.L,,yLJ�ZZ_tr�2L� —Time: /OG.rrt- <br /> (Please allow 10 business days from decal f applleatlon Submittal- Taote011 only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$103 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 EHD USE ONLY <br /> -- city n E] Unlit <br /> t Name <br /> Street R Streer <br /> n/ MALni5_T C / 3 MAeAvl n7, <br /> ��� 2• /'(800_ 6'Ra.v729Gk' Rra, n>JdlolNv�Diy�� N•F�F. DRnz <br /> nits <br /> 5 ,Oe5N003 <br /> Som - y .q9 <br /> 5, nit a <br /> 6. <br /> 7. ❑ Unit 6 <br /> 8. <br /> 9, - ❑ Unita <br /> 10. <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ill UNDERGROUND TANK IU ST)CLEANUP SITE(LOP) M HOUSING ABATEMENT 11 SOLID WASTE FACILRYNEHICLE "t I <br /> ■OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> as UNDeR ROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL EI DAIRY <br /> • HAZARDOUS WASTE OFNERATOR 9<, O CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT v <br /> •TIERED PERMITTED FAr,II„ITY0MOTELIHOTEL M PUMPER TRUCKIYARDICHEM TOILETS <br /> to TATtOOfRODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE.FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDSARE AVAILABLE FORREVIEW .MONDAY-FRIDAY 8:00 AM-6:00PM - EXCLUDING HOLIDAYS. <br /> t. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, Fax tG(209)464-0138 or mall 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 END 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 avallabie. <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 /> Le pa <br /> P9_ I5 7J�1� a cpt, (0)ED 101 0 it f <br /> FORM <br /> EHD ae-06 s10aI0a <br />