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EHO LOG NUIYIUCK <br /> � <br /> CTIVE� SANJOAQUINCO�86r oN . (I �101 <br /> 'S 'deg awil paniaaa <br /> TE <br /> '�V V f IRONMENTAL HEALTH DEPART ENT <br /> SEP 5 2013 1868 East Hazelton Avenue, Stockton, CA 8520 -623 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www-sJ9ov.org1ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT(SERVICES PUBLIC RECORDS RELEASE ApPLICATlO <br /> Qj'_r <br /> Ile BUSINESSIAGENCY: AFT <br /> APPLICANT: Loz.sul+GM+S <br /> iu CITY/STATEIZIP:flaluat6YtL��°�9L/5P"7 — <br /> ADDRESS: Gan Gay r.l va�i�a FACSIMILE: <br /> PHONE(1): s��GF—�OOo — PHONE(2): Time: <br /> TENTRT(VE'APPOINTMENT DATE; <br /> (Please allow 10 business days from data of application submittal-"Tentative only•must be confirmed) <br /> ❑CHECK 60X TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSEDDATE 9/J /Zpl3AYS <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑ List❑ Map—Description: <br /> EHD USE ONLY <br /> FILE ADDRESS Unit 1 <br /> City o N <br /> Street i! Street Name <br /> J a7na&& S7 ST Unit <br /> I� 2 Qa0 ✓_ cr T n MP s <br /> I� <br /> � EfUnit 3 <br /> 4. <br /> 3. L1unit4 <br /> 6. <br /> 7. ❑Unit 5 <br /> 8, <br /> 9. O Unit 6 <br /> 10. to <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACLL <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑ 3 i 1- <br /> ❑HOUSING ABATEMENT ❑WASTE TIRE 5 If I I�x� <br /> ❑QTHER CLEANUP SITE(NON•LOP) FOOD FACILITY ❑DAIRY .F•'"�"1� (q-I <br /> �i <br /> ;L�=�Jy`,INOERGROUND TANK(MONITORINGIREMOVAL�- ❑ yypgfEWATERTREATMENT�LANT <br /> VEGROUNDTANKo� CHICKEN RANCIU DOG KENNEL ElPUMPERTRUCK/YARD)CHEMICALTOILETS <br /> MOTEl1HOTEL (]LAND USE APPLICATION SITES <br /> A7ARDOU5 WA5TEIHA7IIRDOUS MATERU1LSoL � OOLISPA <br /> ❑TIERED PERMITTED FACILITY Q COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> ❑TATT00100DY PIERCING <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-S:Ohecking the appropriatelAYS <br /> 1. List up to ten addresses In the space above. S®lett the types)of foes from the list head®by <br /> box(es). At least one file type MUST be selectsd- Fax t: zDB 454.0138 or contact the EHD. Applicationsmall to the address Indicated received afters <br /> ranges will not be accepted-for additional assistance with file addresses, <br /> 3:00 pm will be processed the next business day ointment for review will be confirmed approximately ten(10) <br /> 2. The EHD will notify the applicant if any EHD files exist. An app <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 /> require a$125 deposit prior to review. nse 0e`+aF' <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the ex ense of thea Ilcan. <br /> Future file reviews by the same applicant may 9 _ <br /> ` �wY <br /> l' r <br /> VV. MN n le tvr <br /> I <br /> ZO/T0 3�JTidg S1NV1-lnSN00 I3d 660994LSZ6 01:11 £L0Z/50/60 , <br />