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I V CU SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB G & 209I 5545 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> *i REMN�aQ�.^a�ftw'ESITALFfE'#d'TH PUBLIC RECORDS RELEASE APPLICATION <br /> t+n _ <br /> •APPLICANT: �Lfq& tJOhn&I-Wl BUSINESS/AGENCY: Fr-1: &101-;M <br /> ADDRESS: 62yel west PjY)o ff CITY/STATE/ZIP: S fto4g, C4 <br /> PHONE(1): _(316) yo54—(9300 PHONE(2 : (3[O)8Sy-OINRc�-- FA RE-MAIL: �[ <br /> Please allow 10 business days from date of application submittal for the records to bd availabl . to t7 (4m <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below. Select the type(s) of files from the list below 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 for a 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$139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> UNDERGROUND TANK(UST) Street# Street Name City` ,n r/(� y�/7 <br /> CLEANUP SITE(LOP) WOOD I' 1 ""1 SV LO NI//A w " ' r " _L� ❑CONSUMER (� <br /> t ✓ .". „l nnn <br /> OTHER CLEANUP SUE(NON-LOP) r/r • QLD <br /> RL HAZARDOUS WASTE /v Dk RY <br /> TIERED PERMITTED FACILITY 2 <br /> ABOVEGROUND TANK r^�Vi lr/[ <br /> %)-N <br /> /�� [3 PWS <br /> UST (MONITORING/REMOVAL) Vv✓✓ <br /> .i�HAZARDOUS MATERIALS S <br /> 51SPILURELEASE RESPONSE �`'� <br /> WATER DUALITY <br /> SOLID WASTE FACILITY/VEHICLE 4 <br /> ❑FOOD FACILITY <br /> ❑POOL/SPA $ITE MITIGATION <br /> DAIRY 5 <br /> LAND USE APPLICATION SUES <br /> [3 HOUSING <br /> SEPTIC PUMPER TRUCK/ B <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT CUPA <br /> ❑HOUSING ABATEMENT r <br /> ❑MOTEUHOTEL <br /> ❑CHICKEN R CH/DOG KENNEL CUPA-UST <br /> 5 <br /> MEDICAL WASTE FACILITY <br /> ❑TATTOOBODY PIERCING ❑SOLID WASTE <br /> r-1 WASTE TIRE g <br /> COMP INT <br /> ®OTHER(PLEASE SPECIFY): ❑ACCOUNTING <br /> Welt SHO 101 1 <br /> '-BOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> END 4&DS <br />