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hpbko_;H9 Ta I_Y40m-CRA-CHICAGO 42 773-380-6421 T-340 P.02102 F-506 <br /> JUL 0 8 ZU10 `'~Iy wpAwUuy anut,tl'41 t <br /> VIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONt TENT HEALTH 600 East Main St, Stockton, CA 95202-3029 �l <br /> PERMIT/SERVICMIephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ad J <br /> PUBLIC RECORDS RELEASE APPLICATION www.sjgov.org/a5d <br /> fry [ <br /> APPLICANT: Ylah eVe BUSINESS/AGENCY: Cp <br /> ADDRESS: pl ' a-k <br /> - <br /> ADDRESS: Nd ij _ CITY/STATE/ZIP: S LL N 511 <br /> PHONE(1): 651 6 i9 691 3 PHONE (2): IZ� SCIS - , <br /> TENTATIVE'^APPOINTMENT DATE! `— . �8 FACSIMILE: 6-5116 ?9 - !1273 <br /> annnk Yv Fila. 6n M- dt a - br. made2 <br /> (Please allow 70 business days from data of application submittal•"Tentadv�must be confirmed)w, Y{iwrrhursC {p <br /> ❑CNECK BOX T'il EXPEDITE REQU ST-$715 FEE ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS o H 'e <br /> SIGNATURE OF APPLICANT DATE_ <br /> Electronic Information: E] List© Map-Description: <br /> _- FILE ADDRESS END USE ONLY <br /> Street# Streat Name City <br /> z 1�As�... _.... . ._-.�:�.a_ck.�. ]— OZ ; ��ji �aT�r� t 1 <br /> 3_.. . 15.Q, illt�l F viS r�, „a l/J2 � nit2 <br /> 4. — <br /> 5. it 11 C <br /> 6. <br /> 7 — nit4 <br /> 9. RUnitS <br /> 10. <br /> Specific Date Range of Information Requested: From 0 Unit 6 <br /> ENVIRONMENTAL HEAL I tt DEPARTMENT to <br /> RZUNDERGROUND TANK(UST)CI FANUP SITE(LOP) E❑HOUSING ABATEMENT <br /> OTHER CLEANUP SITE(NON-LOP) SOLID WASTE FACILITYNEHICLE 3', �N <br /> UNDERGROUND TANK(MONITOItINGIREMOVAL� ©FOOD FACILITY �WA$TE TIRE tti/I,1 J, <br /> AZARDOUS WASTE GENERATOIL! ❑DOG KENNEL ❑DAIRY I <br /> PTATTOO11101Y <br /> IERED PERMITTED FACILITYt `� ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> PIERCING ❑MO LISPA EL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETs� ry-� <br /> OTHER PA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCWDING HOLIDAYS) <br /> 1. List uo to ten addresses in the space above. Select the rype(s)of files from the list above b checkin the appropriate <br /> box(os). At least one files type MUST be selected. Fax to(2091 464-0138 or mail to the adtlross indicated shove <br /> ranges will not be accepted•for additional assistance with file addresses,contact the EHD. Address <br /> 3.00 pm will be processcd the next business day. Applications received after <br /> 2. The EHD will receipt <br /> of <br /> applicant if any EHD Flies exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt le 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 /> 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$115 deposit prior to review. <br /> S. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> - ENO USE ONLY <br /> EHD 4"6 <br /> 8/27109 <br />