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v;i If( �vva -�Wz iv:gee rrsA 1©40I/04;. II <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> P—NVIRONMENTAL HEALTH DEPARTMENT <br /> 000 East Main Street, Stockton,-CA 95202-3029 <br /> Telephone: (209)468-34,20 Fax: (209)4640138 Web: wvvw.sjgoV.org/ <br /> PUBLIC RECORDS RELEASE'APPLICATION ] <br /> APPLICANT: I e— 10C-r—k a r4-- BUSINI SSIAGENCY: 1t S__r S SC1[1 75E <br /> ADDRESS: 'blit-10 601 Ca 42�rI'v V l(dd K41A1J;-,0 'Tv+ 9 Sf, 7 b a <br /> PHDNE(7):_qlb -&f 73-q2 J 3 p pNE(2); FACSIMILE: { <br /> cCr'� t a l TENTATIVE*APPOINTMENT DATE:Wilk 15/V-_? _ Time: 4(4 <br /> (Please allow tonbusinessdays from Mate cf application submittal-'Tentative only-must be con mad) <br /> 0 CHECK BOX TO EXPEDITE REQUEST-598. CASH OR CHE Y)-REQUEST PROCESSED IN THREE BUSINESS DAYS ti <br /> SIGNATURE OF APPLICANT ��C - DATE SISJ I0a- <br /> El"trpniC Information: ,®•List I]Map-Description: -�0)z 2 a tit i cls /flee 0 <br /> FILE ADDRESS EHD USE ONLY <br /> Street A Street Name _ city - ❑{snit i <br /> �u 15 W. rad ; c Load. T r � N. <br /> 2, L 'L " gyral �iS3 O'y!!1 o <br /> .__ g Unit i <br /> 3- <br /> 7 f a( <br /> 4. ,Z L4 S L) Gc7r Ut. <br /> Tnq C 4 5_-7� <br /> �. �-ha W, gra..;� �,� 2�ad rra <br /> 6. 55 _ Tod c 2 C( T-ra[ � nit4 1 <br /> r' �-UrGt v! r f�a rf'GI' qS3 _k0303 ; <br /> -, <br /> $. 2 I'e1) CGth !I`(l� ledGc TTCCI �f5 � �6Ze �15e:Z5 DUnitS <br /> s. rc [ <br /> (zOad .Tree �tS3GY. I? f <br /> ia• nit6 <br /> 000, <br /> Specific Date Range of Information Requested:From to <br /> y,{ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ) y <br /> UNDERCROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNKNICLE <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY VrWASTF TIRE <br /> f UNDERGROUND TANK(MONITORINGIREMOYAL) a DDC KENNEL M DAIRY <br /> Xr HAZARDOUS WASTE GENEFL470R a CHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 13 MaTELIHOTEL 13 PUMPER TRUCIUYARDICHEM TojLETs <br /> 11 TATTOOIBQ-PIERCING 0POOLISPA O LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY E3 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AYAILABLE PON REVIEW-MONDAY-FRIDAY$:00 AM-5:000 -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 above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD, Applications received after 3:00 pm will r <br /> 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 <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 on by the EHD staff may not be immediately available for review. A new application <br /> may be submitted when the file is avaltable. <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$99.00 deposit prior to review. <br /> EHD USE ONLY <br /> i <br /> i <br /> ERD 40-06 10/29107 <br /> . pUSLfC RECORDS RELEASE APP FORM <br />