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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ) e <br /> I IGS (1�1 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> V Telephone: (209)468-3420 Fax: (209)464-0138 Web: wwwsjgov.org/ehd a <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: &sj,, QIN, BUSINESSIAGENCY: <br /> PM Fiwtra+wwh,�t IKc- <br /> ADDRESS: igco, 1 (a Blvet c4, 7. CITYISTATEIZIP: pacc,lltct fA4 LbT <br /> PHONE (1): qtb) 9-1s- 39 rg PHONE(2): 2zt-3 t to FACSIMILE: dA <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 REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / DATE V,f aht,{ <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1• <br /> to to uSfYiA1� 1 Rr iMh}p i CMQ <br /> �n e 2. loll kM NW' IA CaSp 0'11nit2 II <br /> 3. I) raoc -Sp <br /> U 4. -16o AS < 's- L".t Unit <br /> e 5. est ps ,r-te �� <br /> P6. (A ❑Unit4 I <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> i <br /> ETU-nit s <br /> Specific Date Range of Information Requested: From I clm to Pati N <br /> ,� ENVIRONMENTAL HEALTH DEPARTMENT FILES I bllt:s <br /> D UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q'MEDICAL WASTE FACILITY HISOLID WASTE FACILITYNEHICLE <br /> r66�r�.. THER CLEANUP SITE(NON-LOP) ElU <br /> HOUSING ABATEMENT rvASTE TIRE <br /> 21 NDERGROUNDTANK(MONITORINGIREMOVAL) ❑�F�ODFACiLrrY 21JAIRY 1.14 <br /> ED-HAZARDOUS <br /> � <br /> Er��ASOVEGROUND TANK ["CHICKEN RANCHI DOG KENNEL Q'WASTEWATER TREATMENT PLANT <br /> Lgt t <br /> nAZARDOUSWASTE!HAZARDOUS MATERIALS ❑MOTEUHOTEL [� fUMPERTRUCKIYARDICHEMICALTOILETS <br /> 211ERED PERMrrrED FACILITY BfOOLISPA ['LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ['COMPLAINTIRESPONsE RECORDS ['OTHER(PLEASE SPECIFY) 9-r V e.%i+ EHr+U. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) -^ ezH <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$130 deposit prior to review. "*BOXED AREA-EHD USE ONLY" <br /> - f:0"`o- C�OB3u (�?- 22� -. _, dc1 .2�I'-�Cf F5 L' _ • ' 3�! . <br /> ile 7(,0iydjj,,4rjCl e51 s C� � )77 ' a f <br /> U(1 //'LSA , P?".� o G / /-pr XSJ'O�i7`1 X jj p/O.,O' XSd Ui7 . � aC10 ulljf r <br /> �cicf6Qf f 5 :r SJ e�.4f t xSa o.2��.$ XS� D k�ovoi�, xs�ovyol Fc, /Oz/ /r7duSlT1- . <br /> inct'Lolfr-pr x5,16/1/3 , xsj7LC o-ulu7Trial , i'rorldect CAP 1Z11L4/M F'a— 95D /ndu06017'iL1j <br /> io21 ,.adu ial (/nyecLrn /nc d Csrn ?zzrlurts) t' NSI Spelfj� R�rlct ( cDo� 7rdT (vtc(vsfriaf UST;�k) <br /> q5 ,,1fluSf7-1— LU sr LIP_ 4 fo- It 5pe-9 AST f ile duA tc /S. UJR Iet6lb For 74co snctusrrlc) d+wLfc7 <br />