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001/001 <br /> - DATE,REGE�VD <br /> COUNTY <br /> EHD LOG NUMBER <br /> ` SAN JOAQUIN C NTY <br /> - l ENVIRONMENTAL HEALTH DEPARTMENT <br /> �? i 1 C J 1 600 E. Main Street, Stockton,CA 95202-3029 <br /> f 1 Telephone:(209)468-3420 Fax: (209)464-013$Web;www.sjgov.org ee <br /> - wt-"l PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: -f\1'-\ 1• l "1 G'1�7 <br /> t BUSINESS/AGENCY: CC S' C c�r ID &r( <br /> ADDRESS: c��L' ��C:�+rr'>✓l. y G C�k `S L.(-i -}f 1!5"C' <br /> ( (� - ' I S C� <br /> 0 <br /> RHONE(1): -2. PHONE(2): -1(1. -3 <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: -Y 1 C;(V !I 7-C- 61 `—I f <br /> (PICaso allow 10 buslnoss days from date of application submittal-•Tentative only-must be conTlma: <br /> firmed) <br /> ❑ CHECK BOX TO EXPEDITE R QUEST-;95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU$INt SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street tF Street Name <br /> --•- city <br /> unit 7 <br /> 2. <br /> 3. <br /> 4. _... Unit 3 <br /> r <br /> 7. t' <br /> $• ❑ Unit 5 <br /> 9. -- <br /> 10. Unit 6 <br /> Specific Data Range of Information Requested:From A-L+ to <br /> r ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP WE(LOP) 17 HOUSING AWATEMENT EI SOLID WASTE FACILITY/VEHICLE <br /> BOTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY eWASTF TIRE <br /> FIJNDEROROUND TANK(MONITORINWREMOVAL) Q DOG KENNEL <br /> HAZARDOUS WASTE GENERATOR 0 DAIRY <br /> CHICKEN RANCH IlYWASTRWATER TREATMENT PLANT <br /> 11 ATT D/BODY PIE FACILITY ❑MpTEL/HQTEL n PUMPERTRUCK/YARD/CHEM TOILET$ <br /> TATTOO/BODY PIERCING �l'OOL/SPA lad LAND USE APpuCATION ITES <br /> MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) �•p+'C. r i �,�•)� I,t:A•�h' <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:OOpM - EXCLUDING HOLIDAYS. <br /> 7. 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(2091464.0138 or mail to the add=! ' dicated 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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EGHP.46.498/17/2000 web <br />