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11/ZU/Z0UU 1b :28 San Joaquin County —> 4640138 2 <br /> R€EIU�p I` I_jEHD LOG NUMBER <br /> SAN JOAQU1,R t COUNTY <br /> ; �nrj,,.lENVIRONMENTAL HEALTH DEPARTMENT �� <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> T�lephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/e <br /> � 'y i I"-,,1 J PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:__DL"ftR,t Pntti1F' BUSINESS/AGENCY: .5 r.7�nIZ <br /> ADDRESS: gq- N , 5�>✓ J Q,.,,;,u , 5T% +1 a 3v CITYISTATE/ZIP: <br /> PHONE(1): (e2v�i) PHONE(2): FACSIMILE; <br /> TENTATIVE'APPOINTMENT DATE: b(-C Time: ly:cx� <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQI �ST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED iN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE t4oV j9, ,.2oo y <br /> Electronic Information: ❑List❑Map—Description; <br /> FILE ADDRESS EHD USE ONLY <br /> Street# _ Street NamoA Pm _ City ❑Unit 1 <br /> L'ou�lrgy_ CLtt� I}�u lel-.t lo•oR 5Cu('.Kranl _ ., \/,,J <br /> 2. h3 ._— L. )�t�e,PaSH 1'D• 173-0(0 3 ' u - �Unit2 \ <br /> 3' 4N o+5 -im-11 LoDi <br /> 4. 7 ' G IfW Ol'i-D A-Yk l nP.KG(or t> <br /> 5. 3 S N. CHGeoK,,E arm p .,( o.o-; Loot <br /> 6. <br /> Q Ui nit4 <br /> 7. <br /> B. <br /> ❑Unit 5 <br /> 9. <br /> ----- ---------- -- - <br /> 10. <br /> ❑Unit 6 <br /> Specific Data Range of Information Requested: From 1 I 1 Iyhn to (' (A P P 1-N(- <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) ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH E]WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> TATTOOIBODY PIERCING []POOLISPA ❑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 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 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 appilcatlon, The files will behold 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 some applicant may require a$115 deposit prior to review. <br /> 6. If you need further assistance,please contact Diane Martinez,at(208)468.3426. <br /> EHD USE ONLY <br /> EHD 48-08 81270 <br />