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EMU LUG NUMt3tK II <br /> :-REEEIVE0j7 ;',_;;;:l SAN JOAQUIN COUNTY <br /> VL <br /> . <br /> ENVIRONMENTAL H EALTH DEPARTM : <br /> �' �2 �, ���s U 600 East Main St. Stockton, CA 95202-30 <br /> 4� 1 gleh* <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I�D L BUSINESSIAGENCY: F= C-'"I 9 2'(0 z(v <br /> O <br /> Z C1TYlSTATE/ZIP: <br /> ADDRESS: �2- / �p <br /> PHONE 1): 5 - (D PHONE(2): Z�0 0 FACSIMILE- 510- 'a Z Co S(p <br /> { <br /> Time:�..TEVTATIVE APPOINTMENT FATE'. <br /> 2-- <br /> (please allow 10 business days from date of applicA submi eUve $ <br /> only-must be confirmed) <br /> CHECK BOX TO EXPEDIT QUE -$115 F H OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU INESS AYS <br /> SIGITURE OF APPLICA DATE <br /> Electronic Information: gj Llst ap- cript n: i rmrv%e - ,o 0�1 <br /> FILE ADDRESS �� EHD USE o Y <br /> street# Street Name City >r''` Unit1 <br /> �I. �� Oiet L) ;�c� <br /> 2. 1 g NS <br /> t C�n �.� unit 2 <br /> 4 <br /> 4. (� •� Ve- <br /> 32-0- <br /> - Unit 8 <br /> s• 33 f 5� Sn�-SDC 4-0Akv e_ <br /> 6. 2 1 1!v . I�/L G� 1�l �`. _ unit 4 <br /> 8. �Z�o I A ' -l., 3 D,, <br /> F ©units <br /> , 3q FE <br /> 40. 2.n unit 6 <br /> Specific Date Range of information Requested: From P (3- r 'e to _ �� e k-) - <br /> ENVIRONMENTAL FfEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK{UST)CLEANUP SITE{LOP} ❑HOUSING ABATEMENT $OLID WASTE FACILITYNEHICLE <br /> ROTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY -1 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> *HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL UPUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ///❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) j <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 /> boz(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-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 fur 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 EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)458-3425. <br /> EHb USE ONLY <br /> EHD 48-06 <br /> 8127!09 <br /> s <br />