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U//lU/LUUU _LD:04 VAA U001 <br /> DATE RECEIVE EHD LOG NUMBER !I <br /> SAN JOAOUIN COUNTY + <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 <br /> 600 East Main Street, Stockton, CA 95202-3029 n I <br /> "7 JUL � HEAJR elephone: (209)468-3420 Fax: (209) 4640138 Web: www.sjgov.arg /. <br /> Et\X,,��ftil�'�Ci� FiE>aL�h PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: riA nf% i a CIA, BUSINESSIAGENCY: I il&iMhl� (DMk(ALtt <br /> ADDRESS. ��� .. CDIA3AAt CitylStatelzip AQ1J_N�rA 011!gj ,,,,,—, <br /> PHONE(1): �4q-(a$I' 4'1.$7 PHONE(21: Cf�4Gf 3�4-'L�Ob_ . —^FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: �-2?�'D _ Time: <br /> (Please allow 10 business days from date of application submittal-"Tentative only-mustbe anfirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT T� DATE 7-/I,-Q _ <br /> Electronic Information: ❑ List[]Map-;Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0 Unit 1 <br /> 1. S W. <br /> F2• <br /> 22 Uni ❑ Unit 2 <br /> 3 SIN: fin:exlp ( - — <br /> 4 Unit3 nj <br /> 3 of S �' 1� <br /> s. { W 1,o ti <br /> 6 Unit 4 <br /> 7. <br /> Unit 5 <br /> 8. <br /> 9. Q unit s <br /> 10. <br /> Specific Date Range of Information Requested: From 1h C ejA;M to pra . <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYfVEHICLE <br /> OTHER CLEANUP SITE(NDN-LOP) ❑FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ Doo KENNEL 13 DAIRY '1 <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER'TREATMENT PLANT 1I <br /> TIERED PERIAnTED FACILITY ❑ MOTELIHOTEL ❑PUMPER TRUCWYARDICHEM TOILETs � <br /> M TATTOOIBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMITRECORDSARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above: Select the types)of files from the list above by Checking the appropriate I <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—for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:04 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 /> 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 /> .3, A file that Is actively being worked 0n by EHD staff may not be immediately available for review. A new application may be <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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br /> F <br />