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1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> w ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.woov-e 32� <br /> %M00— 7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:'' . L, ° (✓ 1 I(� �J BUSINES /An�GENC - R--NI I I- S FEE 0 Iti CC U� <br /> ADDRESS: "�L/-J 1C i I\ "'l'' �'� ,C �Tl" 7C <br /> PHONE(1): ��(r I J �, �i 17 IIY PHONE(2):<i«.') L4 Ci Flo y 3 FACSIMILE:J- 0`1 S j.3- <br /> TENTATIVE`APPOINTMENT DATE: :9—I ' -C) c' Time: ( r 3n <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE RT 98.00 FEES AS NECK ONLY)-REQUEST PROCESSED IN 3 B SINESS PAYS <br /> SIGNATURE OF APPLICANT DATE v J <br /> Electronic Information: ❑List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street III Street Name City ❑ Unit 1 <br /> 2. <br /> ❑ Unit 2 <br /> 3. \ <br /> 4. � ,1 y Unit 3 <br /> 5. X, A. <br /> 6. 4? ^� v Unit 4 <br /> L.i�1 rJ _Ya <br /> 7. <br /> 8. vN ElUnit 6 <br /> 9. <br /> 10 ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> �111(/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> tnTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY E3 WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTEL/HOTEL Cl PUMPER TRUCK/YARD/CHEM TOILETS <br /> 13 TATTOOIBODY PIERCING ❑POOUSPA O LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY�FRIDAY 8:00 AMS: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(209)464-0138 or mall to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received atter <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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> t <br /> ID <br /> EHo+ede wea elvzom <br />