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RECEIVED <br /> 'OSE i1 ��E'&Ii SAN OAC, LIIN COUNTY EHD LOG NUMBER <br /> %f1/1RQt+1I I41LW&TH ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> F'P1 AlT1 I E� Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.orglehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1?�14L- l�dc BUSINESS/AGENCY: 0 192,IAI � A5S-VG/,9-T07 <br /> ADDRESS: `T �irQltrr-'IQdL{' 'J1,7 CITY/STATE/ZIP: <br /> PHONE(1): PHONE(2):_ /4 �V�j` -7-0�'l 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. 7,110 <br /> � o <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$130 FEE LGA91H 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 /> Street# Street Name City <br /> 1d /aB L/9AI 1190 <br /> . • L 6t�d - do ry (� _/f 51� <br /> 3. ,f�/ t,iln/Rnl�bt/ d 4 t, <br /> 4. Q LTRaP RdA,D T AciC <br /> 5. <br /> 6. <br /> 7. f\ <br /> 9. <br /> 10. <br /> Speck Date Range of Information Requested; From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT El SOLID WASTE FACILITYNEHICLE <br /> WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑F000 FAClLrrY 0©AIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARMUSWASTFIHAZARDOUSMATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA <br /> ElTATTOO/BODY PIERCING E]LAND USEAPPLICATIONSfrES <br /> ❑CoMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REv1Ew. MONDAY-FRIDAY 8:00 Alin-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least ane file type MUST be selected. Fax to 21)9 464-0138 or mail to the address Indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pro 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 flies 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 lby the same applicant may <br /> require a$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY' <br /> I—�-1� ' F--f"'1t.'41.I41 JI' f? � Fl✓1 YGi 1'/l i c.�-�i�\ l7'� ���I�- I .��� +� <br /> ❑ Records provided by Staff-PPR Complete. staff Name: 9 <br /> EH❑4"6 - <br /> 6BFH174 i <br /> P <br />