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EHD LOG NUMBER <br /> )ATE RECEIVED SAN JOAQUIN COUNTY <br /> ��� --f \ ' r� <br /> (�- I, �/ I� l ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3rd Floor, Stockton,CA 95202-2708 /i 3 3 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:wwtv.sjgov.orglelld <br /> UVIVIRION IC-NI HEATH PUBLIC RECORDS RELEASE APPLICATION <br /> i +`•wi1 ; ,,n BUSINESSIAGENCY: ! <br /> APPLICANT: <br /> "-(S:3 <br /> ADDRESS: Z <br /> PHON E(1): 1_-3�Y ��--1— Q PHONE(2):y(� 7 - t ( FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE:_3!1-4/�' rime: <br /> (PI©asc allow 10 business days from date of application submittal-"Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REnQUEST-$93100 FEE(CASH OR CH ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT a'J �-" �'� DATE <br /> UNIT DISTRIBUTION 0 Unit 1 ❑ Un It 2 ❑ Unit 3 Unit ❑ Unit 5 El Unit 6 ❑ Other(electronic/listslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name city <br /> L.► <br /> 2. ZL l`t <br /> 3. <br /> 4. S - L (.• 1 —/"t I►L03 <br /> 6. 2.3 ) }t ' `; o�C I !! VIII <br /> LL I S U — Vl L.e 3 <br /> 'o' -- <br /> 10. � 5 i DQ3cc� <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL_HEALTH DEPARTMENT FILES <br /> ,(� ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> vi JMERGROUND TANK(U 5T)CLEANUP SITE(LOP) ❑WASTE TIRE <br /> 173OTIHER CLEANUP SME(NON-LOP) E: FOOD FACILITY <br /> E]DOG KENNEL 0 DAIRY <br /> ❑ UNDERGROUND TA.%K(MONRORINGIREMOVAL) ❑CHICKEN RANCH n WASTEWATER TREATMENT PLANT <br /> ❑ HAZARDOUS WASTE GENERATOR ❑MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POoIJSPA 13 LAND USE APPLICATION SITES <br /> ❑ TATTOo/BODY PIERCING ❑OTHER(PLEASE SPECIFY) <br /> ❑MEDICAL WASTE FACILITY <br /> WELL ANO SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 Am-5:001`10 - 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 <br /> appropriate box{es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 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 <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review- <br /> EHD 4E-02-006 <br /> tl14195 <br /> T•d 9996-L99 60Z 1-1811V uen nnala dgg:t,0 g0 97 qac <br />