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;118 879 2422 # t/ <br /> EIiD LOG NUMBER <br /> TAT RFn(�E)VED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIfj0NMENTALHPALTH 1868 East Hazelton Avenue,Stockton, CA 95205-6232 t <br /> d <br /> PERMITISERVIGES Telephone:(209)468-3420 Fax: (209)464-0138 Web:Wwttusjgov.orglehd f� 4 { y <br /> PUBLIC RECORDS RELEASE APPLICATION �y <br /> APPU ANT: (J�%tT/ '�t' `�F BUSINESSIAGENCY:�(DK. <br /> ADDRESS: L.S�4 (i�l OAT t/f- ClTY1STATFJZIP: <br /> PHONE(1): —� 13P PHONE(2): FACSIMILE: <br /> TENTATIVEWPOiNTMENTDATE: AP Time: <br /> (Please allow 10 business days from date of appncadon submittal-`Tmtauve only-must be confirmed) <br /> ❑CHECK BOXTO EXPEOrm REQUU —Jf7 R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE x1ifyl`L <br /> Electronic information: ❑List❑Map-Description: <br /> FILE ADDRESS , EHDUSEONLY <br /> streetiF Street Name City ❑Unit 1 <br /> n �C <br /> 2 ..-a 1 1.�`t ❑Unit2 <br /> 3. <br /> 4. d R) J(s1 tp ✓Unit3 C <br /> 5. Q� ``Z"1.rQr �L p I F 1e �(aen L <br /> CM�1 OUnit4 (Y� <br /> t <br /> 7. <br /> S ❑Units i <br /> 9. <br /> 10. o unite <br /> Specific Date Range ofirdormetion Requested: From — to I,f <br /> �r�..•• ENVIRONMENTAL HEAL DEPARTMENT FILES <br /> yyyyyy�rrrrrrtU��^RDERGROUNDTANK(US )CLEANUP SITE(LOP) ❑HOUSINGAeATEMENT ❑ ILIf <br /> SOUDWASrEFACYIVeUcLE <br /> THERCLEANUPSnE(NON-LOP) El FOOD FACILITY ❑WASTETIRE <br /> �r�.NDERGROUNDTANK(MONrr()RINGIREMOVAL) ❑DOOKENNEL ❑DAIRY <br /> y_yffmi musWASTEGENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> jnTIERED PERMITTED FAC(IM ❑MOTE IHara ❑PUMPERTRUCKIYARDICHEMICALTOILETS <br /> ❑TATTDOISODY PIERCING �❑-I PCOUSPA ❑LAND USEAPPLICAMON SITES <br /> [_1MEDICALWASTEFACILITY LJ COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AMD SEPTIC PERMITRECORDS AREAVAILASLE FOR REVIEW: MONDAY-FRIDAYS:00 Am*0OPM(ExCLUDMG HOLIDAYS) <br /> 1. List on 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)464-0139 or mail to the address indicated above. Address <br /> ranges will not be accepted-foraddltional assistance with file addresses,contact the EHD. Applications received atter <br /> 3:06 pm will 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(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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the the 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 applicant. <br /> Future file reviews by the same applicant may require a$125 deposit Prior to review. <br /> I d U- It34 <br /> J r`t ' , � h', <br /> Vie_ L � I C �I �LJ <br /> EHD4"5 fiHIt1 r�`y . <br /> 1 <br /> ***Please respond as soon as possible. <br /> I need to notify applicant during week of 5/1 4/12 if <br /> EHD has files for listed addresses or not. <br />