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DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _t 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> U <br /> F7 C S Teleph)ne. (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> I <br /> PUBLIC RECORDS RELEASE APPLICATIONtt <br /> ir <br /> APPLICANT: S C S� BUSINESS/AGENCY: 6—tt t Q n. <br /> ADDRESS: C, 111'Y4 e'tr-e4- - CITY/STATE/ZIP: foul! lIt _ <br /> PHONE(1): Fr F PHONE(2): FACSIMILE: Gj' S-Tb� <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will conta t you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EX IEDITE REQUEST-$130 FE ASH OR C ONLY)-REQUEST PROCESSED IN 3 BU14NESP DAYS <br /> SIGNATURE OF APPLI ANT DATE C1 /f <br /> Electronic Information: ❑ List❑Map scr(ption: <br /> FILE ADDRESS <br /> Street# Street Name city EHD USE ONLY <br /> 2. ( b 5141 }t ❑Unit 1 , <br /> 9. �r.J:?� a������ `06 , ❑Unit2 <br /> 4. r <br /> I r ❑Unit 2H <br /> 5. ✓L._ _ <br /> 6. Unit3 <br /> 7. �0.1Unit4 <br /> B. i SITE MITIGATION <br /> 9. <br /> 10. <br /> ❑Unit 5 <br /> Specific Date Range of InfonnE Hon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> N GROUND TANK(UST)C EANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACIUTYIVEHICLE <br /> 1€R CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT p WASTE TIRE <br /> �GROUND TANK(MONITO INGIREMOVAL) El FOOD FACILITY ❑DAIRY <br /> GROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> OUS WASTEMAZARDOI IS MATERIALS ❑MOTELIHOTEL - ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑PPOIAPA ❑LAND USE APPLICATION SITES <br /> ❑TATToOIBODY PIERCING cOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT 1ECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. Llst up to ten addressesS in the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one fili type MUST he selected. Fax to f209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be acce ted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identi ying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the z pplicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of ap l!ration. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled Be ordingly. <br /> 4. Any file not returned in he 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$130 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided b Staff-PPR Complete. Staff Name: <br /> EHD 4e-0a <br /> inns <br />