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Dni Dec. 21. 2015 10:46AM <br /> No.■ <br /> ■ SAN JOAQUIN COUNTY ENU LOG NUMBER <br /> ■;■ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 (X) !1 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 'll <br /> �- PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: A j��,1////J �/, 6 01W il?(S BUSINESS/AGENCY:�7couxr', p1q I bL ww�1-5 <br /> ADDRESS: ftVYi • CITY/STATE/ZIP: S-iw&2 95w5- <br /> PHONE (1): PHONE (2): FAX OR E-MAIL: L/ut- 24�l <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK 66X.70 EXPEDITE RE�UES,T�-$�1 j0�FEE ASH OR�CHECK ON L17 _REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �G i DATE (�IC C <br /> Electronic Information: ❑ List ❑ Map-Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> I RAO/vnuc Tyyy tit �- <br /> I�u I1 <br /> 2. I K°1 tf S Gtrl/rt�Q (1 odl�/y 12d TI/l2 roujeJ CA <br /> S (y� '� I�Dl.I� `rl� --- t,� f ta`�n zttl <br /> 4. r ' ' �) � I Z-�-�-t 7 Q"Unit'25. Do '.s �ir✓vrinog1r5 <br /> o Is LOW nus P74 TlAc-/ L,, ,A uv- -(0 Egllnit3HM <br /> a. �:2 W 1466 t-et4n 0Y_ -TVPG I�SITE MITIGATION <br /> g. 32x: S [uacur ar <br /> 10- o OK- <br /> Specific Date Range of Information Requested; From to <br /> _ENVIRONMENTAL HEALTH DEPART MENT_FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q MOTEL/HOTEL SOLID WASTE FACRITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) 2.�FIOUSING ABATEMENT El FOOD FACILITY <br /> r-� <br /> NDERGROUND TANK(MONITORING/REMOVAL) HASTE TIRE �r-�..ttD""A'' IRY,POOLI$PA <br /> [ABOVEGROUND TANK [.CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> �NAZARDOUS WASTE ❑MEDICAL WASTE FACILITY UMPER TRUCK/YARDICHEMICAL TOILETS <br /> r12 RDOUS MATERIALS ❑0TTATTOO/BODY PIERCING LAND USE APPLICATION SITES <br /> IERED PERMrrrED FACILITY Ll COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM5:OOPM ffXCLUDING HOLIDAYS) <br /> 1. List uo to ten addresses in the space above. Select the type(s) of files from the list above 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 $130 deposit prior to review. <br /> 11 <br /> —*BOXED AREA. EHD USE ONLY - <br /> f"N j e n.,1 W,1 1 <br /> Reericwr Tam{iruviu 21,oy2 01fi OrRA`,ONT IBJ Betel. Staff Name: <br />