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❑❑ � f� �y s r _, �r. EHD LOG NUMBER <br /> Q „I SAN JOAQUIN COUNTY (� <br /> o 1868 East Hazelton Avenue, <br /> ENVIRONMENTAL HEALTH DEPARTMENT '� � G� <br /> NOV U 6 2014 Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd r� U <br /> r <br /> ENVIRONMENTAL HEALTFI " <br /> pEr�rrilrlsEl�vlC s PUBLIC RECORDS RELEASE APPLICATION � � , Lj <br /> APPLICANT: Abby Racco BUSINESS/AGENCY: Live OakgQEny`ronmental <br /> ADDRESS: 407 Qak St_ CITY/STATEIZIP: L.odj,_CA 95240 <br /> PHONE(1): (209)36q-0375 PHONE(2): (209) 365-3222 FACSIMILE: 3(oR <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange ail appointment date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQUE -SW5 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1 i _ bf—l `T <br /> Electronic Information: ❑List❑Map–Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Street# Street Nance city Unit 1 <br /> 1. 1 �1,0I Ill 'CJI I (�vt • Lor � L II <br /> 2. 1 E• S' 1"i _ Un►t 2 1 <br /> 3. I 9 U <br /> 4. 1 8">•1 a c �\I "� ff/Unit 3 <br /> 6. it 4 <br /> 7. <br /> 8. ❑Unit S <br /> 9. <br /> 10. I]Unit 6 <br /> Specific Date Range of information Requested: From and a.t� to <br /> ENVIRONMENTAL HF-ACTH DEPARTMENT FILE$ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑(MEDICAL WASTE FACILITY ❑SOLID WA8TEFAC.LrlYlVEMCLE <br /> OTHER CLEANUP SITE(MON-LOP) n HoumnG ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MoNrr0i2 aIREk7oVAL) F000 FACILITY ❑DAIRY <br /> ABOYEGRDUND TANK D CHICKEN RANCH)DOG KENNEL ❑WASTEWATER TREATHENT PLANT <br /> HAZARDOUS WAS OHAZARD l9 MATFRIuS ❑MOTFUROTeL <br /> TIERED PERMITTED FACILITY POOLISPA LAND USF,APPLICATION SM +COIN a^F <br /> TATToo/BODY PIERCING Comps AINT/REsPONSE RECORDS ER LEASE PELF 01A _' VCF_' <br /> WELL AND SEPTIC PERMIT RECORDS ARE AyAILAOLL FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING H I CIC01 7S <br /> 1. List un to ten addresses in the space above. Select the typ (s)of flies from the list above by checking the appropriate <br /> box(®s). At least one file type MUST be selected. FAX to IZo9I dG4-A138 or mail tot address Indicated above, Address <br /> rangen will not ba accepted.Appticetions received after 8:00 pm will be proce66od the next businovv day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. Tho 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 fire Ibusiness datya for mylow. 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 reviewa by the same applicant may require a$125 deposit prior to roview. —ROXEU AREA-EHD USE ONL.,Y <br /> D Records provided by Staff-PPR Complete.Staff Nam©: <br /> Received Time Nov, 6, 2014 10: 16AM No, 7491 <br />