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DATE RECEIVED EHD LOG NUMBER <br /> SAN JQAQUIN COUNTY <br /> 7/.7/J ENVIRONMENTAL HEALTH DEPARTMENT I'A <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 <br /> V Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd 1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Ch eiq-e&f BUSINESS/AGENCY: /U o <br /> ADDRESS: Q2- 'j 1>1+1111- v CITYISTATE/ZIP- <br /> PHONE(1): �(-7i-f7 0(e&IU PHONE(2): FACSIMILE: <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 BOXTO EXPEDITE REQUEST1 5125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑List Q Map-Descriptiorf�/ <br /> FILE ADDRESS EHD USE ONLY <br /> Street#A Street Name CityV. Q Unit i <br /> 2. <br /> 5`t G }]Unit 2 <br /> 3. <br /> 4. �_�. / OI� \ Ll Unit 3 <br /> 5. '�6 Li I t r< <br /> 6. CA ❑Unit 4 <br /> 7. U N t l �c^f-cLv �� �! t <br /> 8. -�t _i ►ct—s+-----= (��� r ❑Unit s <br /> 9. <br /> 10. LI Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ©UNDERGROUND TANK(UST)CLEANUP SITE(LOP) MEDICAL WASTE FACILirY SOLID WASTE FACILITYIVEHICLE <br /> [gC OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT M WASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY DAIRY <br /> [�{ ABOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL WASTEWATER TREATMENT PLANT <br /> Q HAZARDOUS WASTE(HAZARDOUS MATERIALS EIMOTELIHOTEL PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> Q TIERED PERMITTED FACILITY POOLISPA LAND USE APPLICATION SITES <br /> ❑TATFOOIBODY PIERCING COMPLAINTIRESPONSE 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 END 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 fa$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY* <br /> A11` 1 `•}__ t, Inc.{1. :�.�� I 1.� /r r,` �I _% � l /- \.� � 1 i�� <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 4126114 <br />