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09/25/2007 08:51 FAX 530758513.72 FEDEX KINK0'S .DAUIS ` U002/003 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East MainStreet, Stockton, CA 95202-3029 <br /> Telepbone: (209)468-3420 Fax: (209)464-0138 Web: www.sigay.o hd <br /> 113 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> y�N Ind S , �1e t�o f SUSINESSIAGENCY: <br /> APPLICANT•„T - �y f <br /> ADDRESS_ <br /> PHONE � � 75 _1 - PHONE(2): L30� !0246-37- _FACSIMILE: <br /> rin <br /> TENTATIVE'APPOINTMENT DATE: ' e: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confl <br /> CHECK BOX TO EXPEDITE R QUEST $98.00 FEE(CAS HECK ONLY)-REQUEST PROCESSED IN 3 S A <br /> NATURE OF APPLICANT DATE 9 2 <br /> Electronic Information: ❑List❑Map--Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 4 Street Name City ❑ Unit 1 <br /> 1. 74 5- 2. <br /> [33. <br /> fro d a r -1 d De ri Lod z IN,Th ora+vA 4. <br /> g�vb r!.Oct i p�" s ❑ Unit3 ?� <br /> .� ( �I LU v?X �AC.1 � rn.2 vC� ��ri. f ❑ Unit4 <br /> 43 <br /> 80 1-04/., ❑ Unit <br />' - .-.. . .. .8. --5 l az . -.-N��• --�..r� -__". _.._. _ _,C.0 c;Zz.. uP 9�_-a�.98 0 .92 zz�q� io�,�or-�sr�, .. . ....�_ <br /> J <br /> 9+._ ��2 ! t 1 au�lE' c xr�rn I f.ou� fl I775_`910-',� ❑ unite, <br /> 1g rF r �' �atAc 1Gfg Lodi . �YIS 92-09 LA9 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 0 SOLID WASTE FACI <br /> I, OTHER CLEANUP SITE(NON-LOP) i ❑FOOD FA ILITY 0 WASTE TIRE <br /> b UNDERGROUNO TANK(MONITORINGIREMOYAL) OMER <br /> L 13 DAIRY <br /> HAZARDOUS WASTE GENERATOR NCH ❑WASTEWATER TREA ENT LANT <br /> I {3 TIERED PERMITTED FACILITYEL E3 PUMPER TRUCKIYARDICHEM TOILETS <br /> N <br /> 17 TATTOOIBODY PIERCING AND USE APPLICATION SITES <br /> Ci MEDICAL WASTE FACILITY ASE SPECIFY) � - <br /> WELL AND SEPTIC PERMIT O VAv.'ILA0LE FOR REvIEw -MONOAY-FRIDAY 8.00 AM-5:00PM -EXCLUDING HOLIDAYS. <br /> i <br /> 1. List up 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 mall to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD.Applications received after <br /> I 3:00 pm will be processed the next business day.: <br />} 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> tlays after receipt Papp ication The-jiles wIII- e-Ileld-forain imon ofAW-business days_for--review.--App ofntments._�-=____.— _- <br />, <br />' 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application maybe <br /> submitted when the file is available. <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$98.00 deposit prior to review. <br /> EHD'USE ONLY <br /> LHD 48-08 W ER fifa?W7 <br />