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DATE RECEIVED EHD LUG NUMBER <br /> ,�_ '� SAN JOAQUIN COUNTY <br /> `='ro,C4I!V), E U)" <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-2708 <br /> ��(� pU� Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjgov.oF <br /> EWIRONNIEN T HEALTi4 k �O <br /> pE=9 -+r% >E!�11�+, E�'. PUBLIC RECORDS RELEASE APPLICATION_ <br /> APPLICANT:_ �n7 \ -�1��w C jA'�11 " ' BUSINESS/AGENCY: <br /> ADDRESS: P D t�X j?qA 1 10�l� 4� "?' ZU J — <br /> PHONE(1): (,9,0 q) 93 I - Q 0 b PHONE(2): d-�)9 CN d O W,1 FACSIMILE:A C]- s <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 REQ ST-$98.00 FEE(CASH OR HECK ONLY)-REQUEST PROCESSED IN 3nBUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY 40 <br /> Street# Street Name City Unit 1 <br /> 1. L O c S12 <br /> )I , 2. ovi I &q/Sl Unit 2 <br /> 3. tr t (A/61" <br /> 4. Unit 3 r� <br /> 5. <br /> 6. I l 1S Unit 4 <br /> 7. <br /> Unit 5 <br /> 8. <br /> 9' Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) -I DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR d CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY OTEUHOTEL PUMPER TRUCK/YARD/CHEM TOILETS <br /> TATTOO/BODY PIERCING -I POOL/SPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY d 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(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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> *** If you should need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> EHO 48-06 9/14/2006 <br />