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DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> 1�1Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> p�C � <br /> PU13LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: re_v l BUSINESS/AGENCY: 1-4-lob r <br /> ADDRESS: ODV� fir/) �44, P. OZ. CITY/STATE/ZIP: , )Cd C.ra/,,f,�iS ISA/?I Y <br /> PHONE(1): 31'5,- -tI ou PHONE{2): , 9i%-�7(0� FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: I All-2--Z/1 Time: <br /> (Please allow 10 business days from dato of apolication submittal-"Tentadve only-most be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(C R C CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT , -� - DATE 12-111a <br /> Electronic information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City —erlUnit 1 <br /> tJat <br /> I/ -Elf_ <br /> 2. unit 2 <br /> 3. ZD tti� AJa A511 La m <br /> 4. " ( r. ►f r 1� -�(9�7 Unit 3 <br /> 5. cD Pt-E}0.aIe C2%4,C8 <br /> 6. v�_ a� �s o �� 1eS ) 2 �� c�rJ unit4 <br /> 7. <br /> hm <br /> Unit 5 <br /> 9. <br /> 10. <br /> Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLFANUP SITE(LOP) HOUSING ABATEMENT JgSOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY ASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL DAIRY <br /> 9HA7ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PeRMITTLO FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOWBODY PIERCING ❑PooL/SPA ❑LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACILITY ACOMPLAINT RFCORDS ❑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 un to tan 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 mall to the address Indicated above. Address <br /> ranges will not be accepted-for 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 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 file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EMD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> NAD WU 0%Y <br /> EHD 4B-UB <br /> ti11111 <br /> ZO/Ze 09dd ONI -WH1N3S0?1 d3CNS9 b96b8L69TG SO:ET TTOZ/TB/ZT <br />