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05/06/2015 1 : 19 : 07 PM -0400 FAXCOM ANYWHERE PAGE 2 OF 2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN .IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> (�l I C'1r ' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION , <br /> �l APPLICANT: rI '� <br /> ' ��;�� BUSINESS/AGENCY: y1�.foy�rtiQ,� d. rt L <br /> ADDRESS: 3 �� „v`p s Sjj 5422�...... CITY/STATE/ZIP:,,.(tom <br /> PHONE(1): qJq SIS, 3��Jl PHONE(2):�° FACSIMILE: E __ L�„ 7S <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 /> ❑ CHECK BOX TO EXPEDITE REQUEST-$�E(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS DAYS <br /> SIGNATURE OF APPLICANT /G/ DATE <br /> Electronic Information: ❑ List Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 11 Street Name City ❑Unit 1 <br /> U, t C ❑Unit Z l <br /> 3 g. ...... .- <br /> -3- - <br /> rI: <br /> 4. <br /> I .. ._ <br /> Iff Unit 3 <br /> 5. <br /> s ...... <br /> _..............._._..._ — -- <br /> 7. <br /> 8. <br /> _ ❑Unit 5 <br /> 9. <br /> 10. Ll Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> JTjUNDERGROUND <br /> TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILITY SOLID WASTE FACILITYIVEHICLE <br /> HER CLEANUP SITE(NON-LOP) ElHOUSING ABATEMENT WASTE TIRE <br /> DERGROUND TANK(M ONITORINGIREMOVAL) [IFOOD FACILITY ElDAIRY <br /> OVEGROUND TANK E]CHICKEN RANCH/DOG KENNEL ❑WASMVATER TREATMENT PLANT <br /> ZARDOUS WASTEIHAZARDOUS MATERIALS FlMOTELIHOTEL F]PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> RED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑comps-AINTIRESPONSE RECORDS ❑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 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 08101114 <br /> Received Time May. 6. 2015 10: 19AM No. 8638 <br />