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SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �JN 1. 1 2.015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 g 338 <br /> t tNV ONMENTAGH-T phone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> p':Am ';E.RUICEs PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: o <br /> ADDRESS: pl� Lee BUSINESS/AGENCY: 12 T1 <br /> hA' <br /> A� <br /> o CITY/STATE/ZIP: a-I��,{�i Yra v <br /> PHONE(1): _ _ PHONE(2):51 as jgj(jygA06 <br /> FACSIMILE: t/ <br /> Please allow 10 business days from date of application submittal for the records to be available. �v <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 O CHECK ONLY)-REQUEST PROCESSED IN 3iBUSINESS DAYS <br /> SIGNATURE OF APPLICANT l/ <br /> Electeonic Information: Llsi� Map_Description: <br /> FILE ADDRESS <br /> Street#. Street Name EHD USE ONLY <br /> City <br /> Unit 1 <br /> z. <br /> r"" S7 Sfax fi� Uti7-VK.y <br /> 3. o f' c 0-11 <br /> 4. 5 u�_l Unit2 4� I <br /> s. L,/6e Ve. �' <br /> 6. V L"J Unit 3 <br /> Fti SITE MITIGATION <br /> T. /� idUnit 4 <br /> 8. nNtl�k1 �d2'80'S. <br /> 9. <br /> -0 Units <br /> 10. C <br /> Specific Date Range of Information Requested: From <br /> URIf 6 <br /> ENVIRONME TAL HEALTH DEPARTMENT FILES to <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP <br /> ) MEDICAL WASTE FACILITY SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) <br /> UNDERGROUND TANK(MONITORING/REMOVAL HOUSING ABATEMENT <br /> ) WASTE TIRE <br /> ABOVEGROUND TANK FOOD FACILITY DAIRY <br /> CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS ! <br /> TIERED PERMITTED FACILITY MOTEL/HOTEL PUMPER TRUCK/YAP.D/CHEMICAL TOILETS <br /> TATTOO/60DY PIERCING POMPLAINISPA - LAND USE APPLICATION SITES <br /> COMPLAINT/RESPONSE RECORDS�j OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY- RIDAY 5:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. Lisf uo to ten addresses in the space above. Select the <br /> box(es). At least one file type(s)of files from the list above by checking the appropriate <br /> 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..00 <br /> 2. For assistance in identifying the nature and content of EHD re o ds,please contact EHD atthelness 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$125 deposit prior to review. ***BOXED AREA- <br /> �" EHD USE ONLY*** <br /> yN-ly L),M. 2 rG lPsleJl n k4 er , <br /> �^ ( ` w S2C4y COov tial Are- )hbava! Cher 4f <br /> 1ti co 1 57 js � r — ' <br /> El Re w� N <br /> Records provided by Staff-PPR Complete. staff Name: yN5 C Il " I Is I)_SN1�. <br /> EHD 46-06 <br /> . t l9 '16/11/15 <br />