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I (� ��p t <br /> END LOG NUMBER <br /> f�`:�(��^ 0SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 12 2009 600 East Main St. Stockton, CA 95202-2708 <br /> ENVIRL►C>thJEN T HEALTH Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/e <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> a <br /> APPLICANT: BUSINESS/AGENCY: yteyc�r, SJQr� �eS �.r <br /> ADDRESS: CITYISTATE/ZIP: f, fa r�{riTn q Si� <br /> PHONE(1): d PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submfttal-'Tgrifadvo only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQU T-$115.00 FE (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT - DATE <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street R Street Nan a City Unit i <br /> OY r <br /> 2. A T ( � J") `r'%I4 [I Unit <br /> 3. <br /> 4. �. Unit 3 <br /> S. 17Vj <br /> g' ❑ 4 <br /> 7. <br /> 8. <br /> ❑Unit S <br /> 9. <br /> 10. <br /> ❑unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES / p <br /> UNDERGROUND TANK(UST)CLEANUP SRE(LOP) Ll HOUSING SOLID WASTE FACILfTYNEHIGLl; <br /> HOUSING ABATEMENT <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILT Y [3 WASTE TIRE <br /> NDERGROUND TANK(MONrrORINGIREMOVAL)a ❑DOG KENNEL ❑DAIRY i Lr11� r <br /> AZARDOUS WASTE GENERATOR 0� ❑CHICKEN RANCH [DWASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOUSPA ❑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 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addressee In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 a mall 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 flle reviews by the same applicant may require a$115.00 deposit prior to review. <br /> EHD USE ONLY <br /> "**Xf you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You` <br /> EHD X6-06 <br /> 7/3112009 <br /> 100/10018 XVi lb 80 G00Z/ZL/80 <br />