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_ - - -- s CA 9 205 2325 l O Z O l--------------d -1-P -3 <br /> RECEIVED E&ONMENTAL HEALTH o't E n ;W i a n i a a a� <br /> 1868 East -3420 F Avenue, Stockton, <br /> AU 10 ���� Telephone: (209)468-3420 Fax: (209)464-0138 Web:wuvwsjgov.org/ehd <br /> ENVIRONMEN`41-"r 'JH PUBLIC RECORDS RELEASE APPLICATION <br /> FETRT�;air. .L BUSINESSIAGENCY: �I8C1 <br /> APPLICANT: 1 <br /> ADDRESS: '' t`` iRS�iT�(7h1 &tJ iE �/�� CITYISTATEIZIP: S U <br /> PHONE(1): 6551 220-41-91( PHONE(2): SQWACZC ItAI� FACSIMILE: <br /> PCX i o <br /> Please allow 10 business day from date of application submittal for the records to be available. <br /> Staff will contact you to arra a an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDI REQU FEE CHE ONLY)-REQUEST PROCESSED IN 3 B INESS PAYS <br /> SIGNATURE OF APP DATE /D :2,0/ <br /> Eiectronicinformation:' ❑ List❑Map-D cription: <br /> FILE ADDRESS Elio USE ONLY <br /> Sy�0 Street Name City ❑ <br /> VV <br /> 2. X �L lill ❑Unit <br /> 3. ® p <br /> 4. �r,�Vd7.Q,X �! ( (nlD ❑Unit3 l` <br /> 5. <br /> th->51 El Unit 4 <br /> 8- O <br /> 7. <br /> ❑Unit s <br /> 8. <br /> 8. <br /> Untie <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTALHEALTHDEPARTMENTFILES STEFACLRYMMICLE <br /> UNDERGROUND TANK(UST)CLEANUP SRE(LOP) ❑MEDICAL WASTE FACILITY ❑ <br /> IF OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASIETRE <br /> SOIDWAST D� <br /> UNDERGROUNDTANK(MoNDoRNGIRMVAL) ❑FOOD FACILITY ❑ <br /> VC-GIiW ND TANK ❑CHICKEN RANCW DOG KENNEL ❑W6ArS�TEwnATERTREATIENT PLANT <br /> IIAZARDOUSWASTNIf1AZAR000S MATERIALS OMOTaMTEL ❑PuNPENTRUCKIYMDICHEMICALTOKETS <br /> TIERED PERIfrTED FWAR SPA ❑LAND USE APPLICATION SITES <br /> ACILRYTATIOOIBODY PEKING COIpLANTIRESPONSE RECORDS ❑OTHER(PLEASE SPECFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-6:001`I11(EXCLUDING HOLIDAYS) <br /> s of Fltea from the lief <br /> by checking the appropriate <br /> 1, t%@). <br /> Int u°to ten addresses In the space above. Select the type( ) thn address indicated above. Address <br /> box(es). At least one file type MUST be selected. Fax to 12091484-0136 or msil to <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next mmness day. <br /> 2. For assistance In Identilying the nature and content of END 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 thea 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 �xpseI.°rIF�°EHD Uthe SE ONLY <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. <br /> EEO <br /> 4tcA {i(c4 v'w L®for (4)00 Ll alb-Zoirattle LLte r cf E . (oma 11w»�s CO oe3�7f„ LVaao� 71 <br /> Q3 06 c lie t/ elle (-()d0 46V0-r&-'q. <br /> ecords provided by Staff-PPR Complete. staff Name: aero H4 I <br /> EHD 04e �L <br /> JJI <br />