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ag" w 11 NM No, 1893 EI-P- 1G NUMBER <br /> :Ise ' � �� � SAN JOAQUIN COUNTY <br /> ®� SEP , 015 ENVIRONMENTAL HEALTH DEPARTI,.�NT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Wets: wwvd.sjgov.org/ehd <br /> IWRONMENTAL HE/AL`I-H <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �-sk v/Yl ���li l�h l S l3US{I�ESS/AGENCY:S7 GOII,Y)l�]_�]�' (`�uhll G li1/�5 <br /> AMUURESS: ("-?L/ i—_ K(e-j�u I Iy& LITS`/STATE/ZIP: <br /> PHONE(1): C21M) �VS-30SS_ RHONE (2): FACSIMILE: ��,1 �(��- ZGl <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 REQUEST-$130 FEECASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��C DATE 9-I� ^l S- <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS <br /> Street# Street Name City <br /> EHD USE ONLY <br /> �. �3 511 (Aq-P)m K-ep- V-Dld (-J�) - }) Iver �� I�I LIDI I <br /> 2. 32(93 G iil'U I -/f,�,2G1 �f� S,}i�,�cT{D�YI o'Unit 1 <br /> led ­0-1V <br /> 3. >LU GV IVV l. ) SII `r Unit <br /> V 4 �-I 3 Z C�� �� 'J �1� ^ 'C C17"1C1- n t <br /> rG�ln�w it P->✓cU C MOOD)() �x3-W <br /> (0 U/b� S�Gl�'tUn K)l- El Unit 3 ! <br /> (]Unit 4 <br /> Road 6t�7) SjcorV-co 0-91TE MITIGATION <br /> I✓f 1 VU S�li{U�Dj'1 IC ,-"'�ti E-�►r r e!� ` 0 Unit 5 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ,MEDICAL WASTE FACILITY 10 SOLID WASTE FACIL17YNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) HOUSING ABATEMENT tK WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ODAIRY <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL PUrdPER TRUCK/YARD/CHEMICAL TOILETS <br /> R]TIERED PERMITTED FACILITYPOOLISPA LAND USE APPLICATION SrrES <br /> F]TATTOO/BODY PIERCING ZCOMPLAINT(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 fire 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 /> CI Qm Re.z,� Cyr 2 c-h /Jr a�a�,dee I�r �► 3k3'�-� I �� �G{9�5 � <br /> ka un -47`i;b +.-2 Ido 't°c-� ee (� 01' C1J. ,�V„�e� ►- (w k Uo n 7 '711 CU a7 v7� <br /> J G17 Lo r 3"tea t:IdC,f,;we g& m\)yak Co �,,'N,-� C�u�t t of G tiw, <br /> C� y i taU_(240 4 r 3AVA TLo lir u`�c/�. f i a;,Lt 10 wtk 3 <br /> r1 r7ornrrlc r.rr�iirte.d yJ, Q+�ff_DDD �`Q.....1..�.. Staff Name: (�/ 3t{ Z C �4f( Q,}� V�h 5'10( Nt. eI(�1 <br /> Received Time=SeP, 17, =2015= 3: 08PM=No. 9598 <br /> EHD48-os �4f LOWkL07 -7 tuf <br /> x711115 <br />