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DATE RECEIVED` SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> G �'�`"\ r\r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/eh <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �✓r.� BUSINESS/AGENCY: <br /> ADDRESS: CITY/STATE/ZIP: ro.v�s Ud//v <br /> PHONE(1): ��(� y/ PHONE(2): FACSIMILE: <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 /> 1�<C HECK BOX TO EXPEDITE REQUEST- 0 F E(CASH OR CO Y)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List ap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city ❑Unit 1 <br /> 1. 3 �, LO <br /> P s � .n <br /> 2. + ?121 j� ❑Unit 2 <br /> r / <br /> 3. 7�rl�S St ( crus .S ,9I <br /> 4. i r G 5 4 allnit 3 (� <br /> 5, i-or-bile <'te 6. �3 �r��/�% <br /> Unit 4 <br /> 7. A4,4 r Uri <br /> 8. <br /> 15- ❑Unit 5 <br /> 9. <br /> 10. f to Cl d Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) EDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> / THER CLEANUP SITE(NON-LOP) HOUSING ABATEMENTASTE TIRE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) El FOOD FACILITY ]DAIRY <br /> BOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> Zj+IAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING WCOMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(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 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. 'BOXED AREA-EHD USE ONLY' <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 08/01/14 <br />