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DATE RECEIVED EHD LOG NUMBER <br /> SAN �JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.or <br /> �/ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: /l/Ci <br /> BUSINESS/AGENCY: <br /> ADDRESS: Z7�' LAG GC� /�� CITY/STATE/ZIP: <br /> PHONE (1): 65-t') y`� j D PHONE (2): FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city <br /> 4 L:,14,1 / D 7 Unit <br /> CSE' �O G ( I i t <br /> 2. <br /> cc nit 2 <br /> Al - 21 o — /r /Uo Of UD D0(' <br /> PD 4 3 6 V Ce c7_0_ ✓ <br /> 1nit3 <br /> 5. r' S-so ) W/ ��S'�lr% / C DG��/ .A�7 1���7 / I� <br /> 6. y bt Cl 0 /�1 . <br /> 7. <br /> 8. <br /> 9 <br /> El Unit 5 <br /> I10. <br /> ❑Unit 6 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IO'OTDER CLEANUP <br /> TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHIC_LE fVT�'UI <br /> yJ vTHER CLEANUP SITE((NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE UA �� <br /> .UNDERGROUND TANK MONITORING/REMOVAL6(, 0 DOG KENNEL ❑DAIRY <br /> .0 HAZARDOUS WASTE GENERATOR d ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 1/1 <br /> TIERED PERMITTED FACILITY MOTELMOTEL PUMPER TRUCKIYARDICHEMICAL TOILET <br /> Q(1 ❑ El ] <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA OLAND 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(EXCLUDING HOLIDAYS) <br /> 1. List uO 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 -for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. 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 /> 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 /> • _ p! EH U E ONLY <br /> EHD 48-06 <br /> 8127109 <br />