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D,(�,T6 E SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �€ N <br /> • ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC 1 206 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EidJER0Itf1ENTAL44EALTt PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SO,rJ &AA&A/u13 Li�_ BUSINESS/AGENCY: ��T/✓�Tr �FL !P 1 v`C <br /> �4rF <br /> ADDRESS: Lne14t, I .Sfre4e4- CITY/STATE/ZIP: <br /> PHONE (1): e,; J, +76,5600 PHONE(2): N31, ;3 5 G�" ( FAX OR E-MAIL: ° ✓ Es �� , +/ <br /> Please allow 10 business days from date of application submittal for the records to ' vailabl . <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUE $13 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /fin DATE <br /> Electronic Information: ist ❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name Ciry <br /> 1. <br /> 1�'�S C .T CN.N4TES' WAY <br /> 2. ❑Unit 1 <br /> I <br /> 3. p.� - <br /> V nit 2 <br /> 4. p <br /> ` — E]Unit 2H <br /> 5. ItJQS Md it3 <br /> • 6. C rr,, ��11 <br /> �e.."ac� N>✓% Dc. tntF/�4YhH LX11 J� Unit 3HM <br /> 7 SCw'C'1 �Eo 1 t;, Q&A t4 w, nit4 <br /> a' SITE MITIGATION <br /> 9. nit 5 <br /> 10. V or18fta,/ <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MOTELIHOTEL SOLID WASTE FACIUTYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT FOOD FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑WASTE TIRE ❑DAIRY,POOLISPA <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> HAZARDOUS MATERIALS ❑TATTOO/BODY PIERCING ❑LAND USE APPLICATION SITESAI/ I <br /> TIERED PERMITTED FACILITY ❑COMPLAINTIRESPONSE RECORDS PSOTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(EXCLUDING HOLIDAYS) ' t <br /> 1. List uo 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.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 /> 3. 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 /> 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. <br /> • ***BOXED AREA-EHD USE ONLY"' <br /> 0 Records provided by Staff-PPR Complete. Start Name: <br />