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51,`rM 'fx:$ ;' ,5`^ . %1"'.f.�i3�!' .. „a.=" ,,. k xt' krl9lsY W)SX�•+, 1',7 `; ✓ t�• }�� ' ` <br /> e. , <'..1'*"..^Y•'^.ro..'11r,..�=J.�(Jw:{11b�+..-y��.'(l.t...R..r y \\ <br /> SAN JOAQtiIN I w�»...—_..-.e .COU'v• r ..... . ..o .1C"i'F:N 1.V.O Mme' . ':ii <br /> t_J� i TY <br /> r.: ..yy'l•. , <br /> ll lIIJJJ\/ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AI.!F� 1 2005 304 East Weber Avenue,P Floor, Stockton,CA 95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web: www.sjgov.org/ehd jq313. . <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. Dpwj k' PW'� I ' BUSINESSfAGENCY: 642S <br /> ADDRESS:_ Z� Qv. � Of F Tv.r\��1� �(r"1'61 <br /> PHONE(1): Za Csto�— PHONE(2): 2a�.7 j ( -Cat( �G�6Y�'FACSIMILE Z�t (•<o� �'�6 E� <br /> TENTATIVE"APPOINTMENT DATE: Zig 1 Ttme: <br /> (Please allow 10 business days from date of apiplication submittal.*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$`93.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 USINESS DAYS <br /> SIGNATURE OF APPLICANT -V DATE 0�I <br /> UNIT DISTRIBUTION_;] ❑Unit 1 ❑Unit 2 ❑Unit . Unit W <br /> ❑Unit 5 ❑ Untt il ❑ Other(electronicllistsfmaps) <br /> FILE ADDRESS I EHD USE ONLY <br /> street a Street Name ; City <br /> 1• 1?S t w1 5 � 5 cls .� . <br /> 2. 4 . S [✓ Ma. t ' t.Kklzr" L <br /> 3. <br /> 4. <br /> P-4. I l✓scmlQ�+ <br /> 6. %aid-Q <br /> 8• (4 o t!b • find ! CK Yh <br /> 9. <br /> is E. v.�- ,f. ! t, A- <br /> 10. 7J-""L e. Marc Data. >t ! Si<WA <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES Cid��) <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENT t3 SOLIDWASTE FACILrryfVEmCLE E3OTHER CLEANUP SITE(NDN-LOP) 13FOOD FAciuTY E3WASTE TIRE <br /> ❑UNDERGROUND TANK�(MOrNITORINGIREMOVAL) 13 DOG KENNEL I3 DAIRY <br /> 174iAEIlslsoll6+t4*M12eN1MTOR M44401104t wow 43mks""TNtiy1!'117111e1r�lftllT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEm TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA Q LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM EXCLUDING HOLIDAYS. <br /> 7. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to f2091464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will b'e processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist An appointment for review wilt be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staflrl may not be immediately available for review. A new <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> EHD 49-02-006 <br /> 9H6/05 <br />