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q V� EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> JUL 3 0 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIIRONMENfiAL Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> RMfT/SEq�OES� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��( `Qp BUSINESS/AGENCY: <br /> ADDRESS: c CITY/STATE/ZIP: <br /> PHONE (1): _ PHONE (2): 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. <br /> ❑CHECK BOX TO EXPEDITE RE UEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINES DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ Lisf❑ ap-Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> 1. St f� <br /> 2. , <br /> 3. 1* E Onit 1-10 <br /> �r- <br /> —�I RA;'El <br /> a. <br /> Unit 2H <br /> 6. <br /> 5. <br /> J 06 <br /> 7. _ _ ❑Unit 3 <br /> A. <br /> _ / 7 > Unita <br /> $• SITE MITIGATION <br /> 9. <br /> 10. 1 <br /> :�❑ UnitS <br /> Specific Date Range of Information Requested: From to <br /> �1 ENVIRONMErNyTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY ®SOLID WASTE FACILITYNEHICLE <br /> r71 OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT WASTE TIRE <br /> Ls�UNDERGROUND TANK(MONITORINGIREMOVAL) FOOD FACILITY DAIRY <br /> ®.ABOVEGROUND TANKCHICKEN RANCH/DOG KENNEL LRWASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS MOTELIHOTEL W PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ,TIERED PERMITTED FACILITY POOLISPA LALAND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING 9COMPLAINTIRESPONSE RECORDS Q OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <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 /> J1I4a L-,STt•11e Wr- l)0 IAw.'ber v 1 vlawA tgST�1It5 r 42Htih�y1te (.e:,�.k,� i,rl, <br /> to jea 614ez 4vp, qn � Iu>rk LU l"ob 17. Iln'w{ L20v 27 Dal 244 <br /> Ckk' kT (,ll �O1.1e6e/Aue. Iwln1 142w ;L-7175 i5t ih LAS"C i4je tor 13 `+„tor <br /> Ave. A Ckeu- m t i S n1� <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHO 48-05 <br /> 7/1/15 <br />