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r <br /> EHD LOG NUMBER <br /> )ATS:RECEIVED SAN JOAQUIN COUNTY <br /> (7—It l} ENVIRONMENTAL HEALTH DEPARTMENT <br /> E IS 11 L�� <br /> 304 Fast Weber Avenue,3rd Floor, Stockton,CA 95202-2708 <br /> Telephone: (249)468-3420 Fax: (249)464-0139 Web:ww%v.sjgav-vrgfeFtd <br /> ENVEC�l�C,={�T �IEP�Lfi PUBLIC RECORDS RELEASE APPLXCATION` _ - Y <br /> 13USINESSIAGENCY: ' <br /> APPLICANT: ' <br /> ADDRESS: � r 1,:�+ " �. +�rt `� lattS V <br /> PH ON E(1): 7--)ti �� — 4 PHONE(2)�: <br /> L <br /> Time: <br /> 5 ( FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 3 <br /> , �5^ <br /> (Pkiase allorw 10 business days from date of application submittal-•i e+Rtative only-must be confirmed) <br /> 11CHECK BO%TO EXPEDITE REQUEST-393100 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED iN 3 eU51NE55 DAYS <br /> �s r �;.—� - DATE L[ 3� <br /> SIGNATURE OF APPLICANT ' <br /> UNIT DISTRIBUTION <br /> a Unit 1 E]Unit 2 ❑ Unit3 Unit4 M Units d Unit 6 Ca Other(electronicllistsltliaps) <br /> FILE ADDRESS EHD USE ONLY <br /> street¢ Street Hama h: city <br /> I. 3 l`4 T I;1 r o i c. J :?.' Zt <br /> Zi-{`-'l i\\ L. <br /> 2. <br /> 3. 4 cJ 's ' �.� L- <br /> 4. S — � i tom. .P ."'.1- (�., � '�✓Y=1• �Qr4' e <br /> 7. � —I ;D.-hr <br /> 10. <br /> Specif)c Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑HUusmoABATEMENT ❑SOLtDWASTEFACILITYNEHIcLE <br /> .INpERGR011NDTANK(UST)CLFIINUP SITE(LOP) ❑FOOD FACILITY »WASTETIRE- - <br /> C7 OTHER CLEANUP WE(NON-LOP) M DOG KENNEL C3 DAIRY <br /> M IjNDERGRWNDTANK(MowrromnG1REMOVALI ❑CHICKEN RANCH n WASTEWATERTREATmENTPLANT <br /> ❑ HAZARDOUS WASTE GENERATOR - ❑IJIOTELIHOTEL - ❑pLjMpERTRUCWYARDICHEM TOILETS <br /> E3-nERED PERMITTED FACIJTY ❑POOLl8PA I]LAND USE APPLICATION SITE$ <br /> ❑TATTOOJBODY PIEF=NG ' <br /> ❑MEDICAL WASTE FACILITY A DTHER{PLEASE SPECIFY) <br /> WELL ANDD SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW• MONDAY-FRIDAY 8:00 A -S DOPM. ,EXCLUDING HOLIDAYS. <br /> 9. 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 filetype MUST be selected. Fax to f 209 464 0138 o_p2 ail 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.c)ay. <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 licarelent maysed )ll be reorganized by EHD require a$93 00 depositrioexpense of the <br /> r to review. <br /> at the Ful tore file reviews by the same app <br /> EHD 41142-0x9 . <br /> U14105 <br /> z d i $996-L99 60Z I1911V ueA m8JG d95-V0 go 8Z qej <br />