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DATE RECEIVED /� �y-r 1�• F <br /> Cony EHD LOG NUMBER <br /> r ! SAN .JOAQUIN COUNTY <br /> -7 /qENVIRONMENTAL HEALTH DEPARTMENT <br /> y- <br /> - L 1868 East Hazelton Avenue, Stockton, CA 95205-62w32 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: ww .sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION f <br /> APPLICANT: V'l6(a BUSINESS/AGENCY: �1 UQS <br /> ADDRESS: (pasfue`<t QtctCt lurkQ CITYISTATEIZIP: eOR4,OVIOC_ Q') PR (M& <br /> PHONE(1): 0144 PHONE(2): FACSIMILE: (9IO- 83G- 35o <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrang Int an appointmedate and time to review the requested records. <br /> [:]CHECK BOX TO EXPEDITE REQU T-$12,; A O%R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Ll Un <br /> I. tb5a6 MLQOh (1_Ac'kly co ( 1I <br /> 2. �t OO �`t�2G,1 L-t+'`VT 1 `•`�- Q Unit] <br /> 3. ILyn / <br /> 4. )/�✓��11 l �J Unit 35. <br /> �) <br /> 7 2 ^. / <br /> 6.- �'1 � F-1ilnit47. <br /> � <br /> i <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ®Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> BOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> WIRAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> (ZilIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> TATTOO/BODY PIERCING WOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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.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 fora 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$125 deposit prior to review. ""BOXED AREA-EHD USE ONLY*" <br /> ❑ Records provided by Staff-PPR Complete. staff Name: <br /> E11048-06 6/28114 <br />