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RECEIVED 0 <br /> EHD LOG NUMBER <br /> DATEdR6FlEA 2013 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT/SERVICESTelephone: (209)468-3420 Fax: (209)464-0138 Web: www-sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> CtT�TATEIZIP: <br /> APPLICANT/ VYt a,(AA SINESS/AGENCY: <br /> 1A. / <br /> DDRESS: <br /> PHONE /(� �`Yr"� PH�L1E(2): FACSIMILE:r�CJ�J <br /> TEN ATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business d y a of application submittal-*Tentat ve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RE ST 5 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> ElectronlcInformation: ❑List Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name city <br /> ❑Unit1 <br /> 1. g sfree P <br /> � (JD C.D S� ❑Unit 2 <br /> �D ,/ <br /> z r fY� <br /> 3 —qtr rSC3 � 1'°1 <br /> 4 Unita ` <br /> Lg <br /> S. r� 0�101 <br /> s ,_,/Unit4 <br /> 6. <br /> 7. r 2- 00 C-O* <br /> ❑Unit 5 <br /> B <br /> 9. <br /> 10. �, 1G to ❑Unit 6 <br /> Specific Date Range of Information Requested: From <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ,� 11 <br /> SOLID WASTE FACILITYNEHICLE y,� ' <br /> KVlj'NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑ lj <br /> HOUSING ABATEMENT' ❑WASTETIRE (�-17y 01❑O ER CLEANUP SITE(NON-LOP) E]HOUSING <br /> ERGROUND TANK(MONITORINGIREMOVAL) ❑ ElFOOD FACILITY <br /> [XBOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATERTREATMENT PLANT <br /> IM1fZAR000S WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPERTRUCKIYARD/CHEMICAL TOILETS <br /> El TIERED PERMITTED FACILITY ❑POOLISPA ❑ <br /> LAND USE APPLICATION SITES <br /> F]TATTOOIBODY PIERCING ❑COMPWNTIRESPONSE RECORDS [j OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> List uo to ten addresses in the space above. Select the fype(s)of files from the list above by checking the appropriate <br /> 1. <br /> box(es). At least one fate type MUST be selected. Fax to(2091464-0138 or mail to the address indicatedabove.iveAddress <br /> ranges wlllnot beaccepted-for additional ass(stance with file addresses,contact tfie EHD. Applications reced atter <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant)f any EHD files exist. An appointment for review will be confirmed approximately. Appointments <br /> ppontmnt n(10) <br /> days after receipt of appltration. The files will be held for a maximum of five business days for review. App <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. Anew application maybe <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$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ERecords provided by Staff-PPR Complete. Staff Name: E 914112 <br /> EHD 441-06 <br />