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ro: Page 3 0 , 2014-10-07 11:45:49 EST 19169622678 From: Lily Mullins <br /> DATE ggcb(ED EHD LOG NUMBER <br /> "?lad SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> hone: (209) 468-3420 Fax: (209) 464-0138 Web: wvvw.sigov.org/ehd ` <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: j�j3t7 Prt a ! I Lf CITY/STATEOP: 5 :r Oa ,C/v 13fa;-S <br /> PHONE(1) t t �� iL PHONEFACSIMILE: CFla "icD-.26-79 <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 EOUEST-513 EE(CASHOR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4 <br /> DATE ' (t 0 <br /> .. .. .. <br /> Electronic Information: El List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY '.,. <br /> Street M Street Name City ❑Unit1 <br /> tA <br /> Waft <br /> �. t..t <br /> 2. <br /> 3. <br /> 4.._r........ ..._._,._._ _ __ t O/UH Unit 3 . <br /> B <br /> nit 4 <br /> 8. <br /> Unit S <br /> t 9. <br /> 10. <br /> ®Unit 6 <br /> -Specific Onto Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES - <br /> LI DS;U C TAM(LISO)CLEANUP SIE(LCP) ..❑MEDCAL WaSra FACLITY .".. " ❑SQJD WASTE FAOLrrY/V91O.E . '. <br /> 10a-eRCLEMPSrrE(N:N­L0M�.. . . :. � ❑H7F_ihlaABATBu8J1' ...❑V>L45fETIF� ... <br /> . UJIDER'3tOd`OTANS(MWTOR�AL) ....._.. ,..❑FOS/FACILITY DAIW .. . <br /> AeaaflawTMx ❑O4OEN PIAND-y DCG KHSH ❑VVM-MV4TETTREATNBJ11'FLAW <br /> HVARDOUS W4ST6+"AR0CUS MATE4ALS <br /> ❑Mnahi7ra. ❑Fv1V1ERrlanUYARD17-eV,riLrat Els <br /> Tiff®PERvITTEDFAOLffY ❑P=/S=w ❑LAND iISEAMIC PONSTES <br /> ' ❑TATfOd6o:7(Ple:oNa 177tvRA1M(F FSEs ❑OTHER(R.EASESOiFY) <br /> WELL AND SEPTIC PERMrr RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:00 AM-5:00pm(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 after3:00 pm will he 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(1o) <br /> `days after receipt of application. The files will behold for a maximum of five buslness 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.staft Name: <br /> eno q& 6 <br /> .__......... . . _.......... . ............... .................._. _.. _... .. _.__...... ....__ ......__.. <br /> Received Time Oct, 7. 2014 9:42AM No. 7266 <br />