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L..I f`-i 1,^ i'"7-}ire ""'n IV ILLC <br /> 5100559517 T-954 P 02/05 F-713 <br /> :7 ='i_ � !J1 bAN JOAQUIN GOUNTY <br /> AVIRONMENTAL HEALTH DEPAR-k HENT <br /> ,jwl 0 5 ZQ[!8 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgQv.p /e <br /> 7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (jt _ D WTI',/� 1� <br /> ADDRESS: b L rn �/t3P4 D ST <br /> � EUSINE88/AGENCY: <br /> PHONE(1): � it1 .��y Q <br /> �U0" " <br /> PHONE(2): <br /> TENTATIVE"APPOINTMENT DATE:_[o I i 1 I 08, FACSIMILE��/�) <br /> (Please allow ten business days from ate of application submittal-•Tentative onTlma. ' <br /> t� CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR GHECK ONLY)-REQUEST PROCESSED N THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑ List ❑ Map - Description: DATE <br /> FILE ADDRESS <br /> Street# Street Name city E O LY <br /> City C <br /> OtS I Unit 1 <br /> 2. d <br /> 3' 0 n0 L/I it a 5PC "11 <br /> (� nitz <br /> 4 <br /> V " <br /> 5. 2.. nit 3 <br /> 2d CiO��- osprp"` <br /> h 7. a,-14571 nit <br /> nit 5 <br /> SOtAiVL PwtCViccth 5111 1!� <br /> Unit ti <br /> /L4 <br /> Specific Date Range of information Requested: From �Q v� <br /> to <br /> FNVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITELOP <br /> OTHER CLEANUP SITE(NON-LOP) SITE( <br /> ) Q HOUSING ABATEMENT <br /> UNDERGROUND TANK(MONITORING/REMOVAL FOOD FACILITY SOLID WASTE F gCILITY/VEHICLE <br /> )� DOG KENNELWASTE TIRE <br /> HAZARDOUS WASTE GENERATOR'> ❑DAlRY <br /> TIERED PERMITTED FACILITY:�. ❑CHICKEN RANCH WpsTEwg7ER TREATMENT PLANT 1M <br /> TATTOO/130DY PIERCING MOTEL/HOTEL 6 <br /> �POOLISPALAND <br /> UPUMPEE APPLICATION HFM SITESTOILETS <br /> � MEDICAL WASTE FACILITY LAND USE APPLICATION SITES <br /> Q OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking theappropriate <br /> bOX(es). At least one file type MUST be selected. Fax to (209)4ti4-0138 or mail tli the above address, <br /> not be accepted-far additional assistance with file addresses,contact the)=Hp, Applications received after s r pm will <br /> be processed the next business day. Address ranges WIII <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be conFlrmed a <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. approximately ten <br /> 3. A file that lis actively being worked on by the EHD staff may not be immediate) available for review. A new a <br /> may be submitted when the file is available. <br /> y y <br /> 4- Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> e applicant. <br /> EHD USE ONLY <br /> EHD 48.06 10/29107 <br /> PUBLIC RECORDS R6LEA$E APP FORM <br />