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DATE RECEIVED 1 ti EHD LOG NUM R <br /> '�/ <br /> RECEI ED. SAN JOAQUIN COUNTY <br /> `�—=? <br /> NVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 112014 1 E 68 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> ENVIRONMENTALHESLTH PU13LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: vlSa 12c� BUSINESS/AGENCY: 9 04? ry Nli��%I�G 11�L <br /> ADDRESS: 531( -1 Co "'1=_ C,yL CITY/STATE/ZIP: f-Uclt: 4 9'5 6 <br /> PHONE(1): c,2 Z y-7 6 6 G G PHONE(2): ,�Z C - ( (�(7FACSIMILE: <br /> TENTATIVE*.APPOIN MENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> FIC i HECK BOX TO EXPEDITEREQUE (CAS�Q �OLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATRE OF APPLICANT DATE -- - / / — / 4/ <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FIL.E ADDRESS EHD USE ONLY <br /> Street# Street Name City El Unit 1 <br /> 2. <br /> MmLOS ❑ Unit 2 <br /> 3. 1/�o <br /> 4. ..,d_Unit 3 �C <br /> 5: <br /> 6. <br /> Is�Unit 4 <br /> T r <br /> 8. <br /> ❑ Unit 5 <br /> 9. <br /> 10. <br /> ❑ Unit 6 1. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> rju,NDERGROUND <br /> DEP.GROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE 1 �`�eS <br /> HER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE J` <br /> TANK(MONITORINGIRE OVAL) ❑FOOD FACILITY ❑DAIRY <br /> OVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> L I� <br /> RDOUS WASTEIHAZARDOUSMATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING Vf 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-fo additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicar t 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 according y. <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 file is available. <br /> 4. Any file not returned in the sam D condition as released will be reorganized by END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review_ ***BOXED AREA-EHD USE ONLY*** <br /> � <br /> S '`k-L. C600-_37-�-7 see elyei 3•- . <br /> iJ e C'XO.3 -0u - /Z W. ) <br /> ❑ Records provided by Staf PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 9(4/12 <br />