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d_ d/18/2006 10:59 FAX <br /> DATE REccrvEE(D�' `� �7 (� Z002/002 <br /> [R r-''E�1U/� II SAN JOAQUW COUNTY EHD LOG NUMBER <br /> ll L� 1J �— L'�!LI,NVIITiONMENTAL IRFALTH DEPARTMENT <br /> JAN 1 n,�QO East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> ep one: (209)468-3420 Fax: (209)464.0138 Web: www sjgOv.Org/ehd I <br /> ENVIRONMENT HEALTH 3 <br /> M1�7,SERVITUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I�V17r+rt c SSIy S �. <br /> ADDRESS: � susmEss/AGENCY: <br /> CITYSIk <br /> $TATEPHONEf1PHONE(2) ._•��cy_ <br /> FACSIMILE: '-g, 9`f P" fly <br /> TENTATIVE*APPOINTMENT DATE: 7 / I /h(o <br /> (Please allow 10 business days from date of a hcatlRNl aubmatal. Time: I Z <br /> PP Tentative only-m ust be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REO% T-$93.00 FEE H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT IxA /L� �_ <br /> DATE <br /> Electronic p List 0 Map P-DeacdpNon <br /> FILE ADDRESS <br /> street stTeetName C� EHD USE ONLY <br /> 2' 1- ) ❑ Unit 1 <br /> 3. <br /> 4. ti I e Unit 2 � S <br /> 6• O Unit 3 <br /> 8, jr Unit 4 <br /> 100, ElUnit 5 <br /> Unit 6 <br /> Specific Date Range of Information Requested:From <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tSf UNDERGROUND TANK(UST)CLEANUP SITELOP <br /> .OTHER CLEANUP SRE(NON-LOP) (LOP) ❑HOUSING ABATEMENT _S SOLO WASTE FACILITYIVFNICE <br /> L2F1UmveRGROUND TANK(MONITORINGIREMOVAL) 0 FOOD FACILITY <br /> Y ❑WASTE TIRE <br /> Qtl HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH `/��7.DAIRY <br /> ❑TIERED PERMITTED FACILITY p MOTERJHOTEL F�YYA57EWATER TREATMENT PLnflr <br /> ❑TATTOOIBODYPIERCWG0 PUMPER TRUCKNARD/CHEMK:AL TOILETS <br /> 11 MEDICAL WASTE FACILITY p POOL/SPA LAND USE APPLICATION SITES0 OTHER(PLEASE SPECFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVARMLE FOR REVIEW-MONDAY-FRIDAY 8:00 AM.0:00pu . EXCLUDING HOUPAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to(2091484-0138 or mail to the T:Iddress <br /> Indicated above. Address ranges will not be accepted—for addltlonal assistance with file addresses, contact <br /> the EHD.Applications received after 3;00 pm will be processed the next business day. <br /> 2. The EHO will notify the applicant If any EHD files exist, An appointment for review will W confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> r.2 <br /> ENO 4ij1r <br /> 10fJVL006 <br />