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p�i D.,r. �; EHD LOG NUMBER <br /> �.- ""`' SAN JOAQUIN COUNTY <br /> SEP .03 2015 ENVIRONMENTAL HEALTH DEPARTMENT {GC? <br /> 1868 East Hazelton Avenue,.Stockton, CA 95205-6232 <br /> ( jz dephone: (209)468-3420 Fax: (209) 464-0138 Web: wwwsjgov.org/ehd <br /> r,NVIRONMENTALHEALrs <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION t <br /> APPLICANT: 1'�q". /t/j_94ti' BUSINESS/AGENCY: � "ela /'L�a�✓LJ <br /> ADDRESS: /O.3 CITY/STATE/ZIP: f7 /7v j S3J/ <br /> PHONE(1): x7- 7"-I�f-71/&0 PHONE ,FACSIMILE: 27S - 2SY-37r/S1t <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 dat ,and time to reviewthe requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST$7�( (CASq�'#�CJ' C -REQUEST PROCESSED I(�/BUSINESS DAYS <br /> SIGNATURE OF APPLICANT `` v DATE (/31/S~ <br /> Electronic Information: ❑ List ❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. L(,2n LJP+ ReP,*5-c4 <br /> 2. ❑Unit 1 <br /> 3. ❑Unit 2 <br /> 4. ❑Unit 2H <br /> 5. ppp <br /> 6. �Unit 3 qh <br /> 7. ©/Unit4 ` <br /> 8. ❑SITE MITIGATION <br /> 9. <br /> 10. ❑ Unit 5 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> E;�IJNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 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 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 /> 2,11 AEk c . <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4846 711115 <br />