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m D 9� t' ��iPM SAN JOAQUIN COUNTY No, 0 13 9 EH P. 1,NUMBER <br /> ■ <br /> INN APR 0 9 2015 ENVIRONMENTAL HEALTH DEPARTMENT <br /> I. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> E-NVIRONMENTAL '&. Jayhone: (209)468-3420 Fax. (209) 464-0138 Web: www.sjgov.org/ehd <br /> PrrRMITfSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: t�f '� ✓1J^vvir,e <br /> ADDRESS: s:338 CITY/STATE/ZIP: <br /> PHONE (1): 158�_00 _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 REQUEST-$13 E SIT R CHECK ONLY)-RE ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT l DATE <br /> Electronic Information: ❑ Llst❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street <br /> -# Street Name City ❑ Unit 1 <br /> 2. r ❑Unit 2 <br /> vil <br /> 1,�O e r-,4 6 �C�� G Unit 3 <br /> [5. 1p Unit 4 <br /> . <br /> g. ❑unit!; <br /> L110 <br /> ❑"Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> J <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLFD <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT WASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) F1 FOOD FACILITY ❑DAIRY <br /> BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL INIVAST EWATERTREATMENT PLANT <br /> ,HAZARDOUS WASTEIHAZARDOUS MATERIALS Q MOTELIHOTEL 1:1 PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ,TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING �COMPLAINTIRESPONSE RECORDS E]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 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 (2 9)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 /> S. 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 appllcation. 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 QNLY"* <br /> ❑ Records nrovided hy.Staff-PPR Complete. Staff Name: <br /> Received Time=Apr, 9...2015= 3 . 17PM=No; 8496 08101/14 <br /> gnu uo-vo <br />