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��o �/ <br /> ""'�v� % SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> TUC U 1015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENT Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> d�RMIr�sEr��ESQ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: AZ'4&( , c ' et BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (1): _ PHONE(2): FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE PEPUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINES9 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List[-] Map-Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 1. 13n 5-to C, , � <br /> Un <br /> 2' [] itt <br /> 3. ' C I .-�ZU nit2 �• <br /> 4. $ ���1 ''jA Unit 2H <br /> 5. 1 (r' 0 k' J e5 a�„1 <br /> 7. r Unit <br /> 8. - IA-I IV / 1 SITE MITIGATION <br /> 10. <br /> U Is <br /> Specific Date Range of Information Requested: From to <br /> ccc���555 ENVIRONMENJAL HEALTH DEPARTMENT FILES . <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) US MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> rr77�1 OTHER CLEANUP SITE(NON-LOP) Q HOUSING ABATEMENT WASTE TIRE <br /> rLJ- UNDERGROUND TANK(MONITORINGIREMOVAL) FOOD FACILITY DAIRY <br /> 69ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL LRWASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS MOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY POOLISPA LAND USE APPLICATION SITES <br /> [2TATTOOIBODY PIERCING 9COMPLAINTIRESPONSE RECORDS U OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 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.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$130 deposit prior to review. ***BOXED AREA.EHD USE ONLY*** <br /> Jutda t�ST We W r 13u At'iter L C vaal twr ket r 42 %hhr 14e co -bo iv,la <br /> to +ea nlhe i• hAn+ 15G'�-i. -4 CJ w 17 O 1x7 Z44 <br /> ajX' In Z Ale kr tW ~ (ca"t 1-71-15 jc& i&14Le Wn j A IC 40 r 13 S rtlme/ <br /> T che1A re / 15 m1 <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD M-06 <br />