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! 1 ��� %"e EHD LUG NUMBER <br /> 7r,"Lff �� SAN .laAQuiN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2008 600 East Main Street,Stockton, CA 95202-3029 <br /> Telephone: (209)468-8420 Fax: (209)454-0138 Web:waw,sjgOV.orgleh I q7D <br /> ENVft'0WFN-1 HEAJH <br /> ,10, E`ER-�t1+IGEIS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: [�E?�ah A 1n ��Ctls'3 m BUSINESSIAGENCY: ET S <br /> ADDRESS: �ok t't Lt)2 (A\ - C1ty1$kptvl2i� <br /> PHaNEf1): -7 lljrlC? PHONE(2): I ACSIMILE: n.7-�$`(` <br /> TENTATIVE"APPOINTMENT DATE: I'�� - —Tim: 0L00---- <br /> (Plea" <br /> U0(Please allow 10 business days from date of appllcatloR eubmlrial-*Tentative only•must be confirmed) <br /> .tel CHECK Box TO UPEDITE REQUEST $ o F ( sH CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: [a List[]Map-Description: <br /> FILE ADDRESS _. ...._. F-HD USE ONLY <br /> Street—r- Street Harm City <br /> n ik <br /> Y <br /> 2• 1 �] Unit 2 <br /> -.. _.,.._... 0 <br /> s. E _. <br /> 4. ' _ U units <br /> 5- <br /> -- unit 4 <br /> 7. <br /> ❑ Unit 6 <br /> © Unit 6 <br /> Specific Date flange of Information Requested:From Al 0 to _._j=00`7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NOtR0t10VND TANK(UST)CLEANUP SITE(LOP) 0 HOU51Na ABATEMENT G SIXID WASTE FACILITYIVENICLE <br /> 10 071-iErtCLEiANvp SITE(NON.LOp) 0 FOOD FACALRY n WAbS1=T1Re <br /> ❑UNDERGROUND TANK(MCWTORINGIREMOVAL) DDG KEtiNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR C}CrHK7KEN RANCH 13 WASTEWATER TREATMENT PLANT <br /> 0 TIERED PtAMITTED FACILITY 0 MOTELIHOTEL ❑Pummn TRUCKIYARD/CHEM TOILETS <br /> 0 TA711OOIBODY PIERCING 0 POOI.iSPA 0 LAND USE APPLWAYIOW SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY)....... <br /> _ WELL AND SEPTIC PI:RNi I RECORDS ARE AVAILABLE FOR f2EVIEw-MONDAY-FoDAY$:Dc Ary5.6:DQPM -EXCLUIMNO HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(sa). At least one file type MUST be Selected. Fax to(2091454-0"f�0._4Lmaif to the address indicated above. Address <br /> ranges will not be accepted--for additional assistance with fila addressees,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after tviceipt of spiAlcation. the files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A fll$that is actively being worked on by EHD staff may not be immediately available for review. A new application maybe <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 retlulre a$145 deposit pr€orw review, <br /> EHD USF=ONLY <br /> EHD 4$-46 $7b410$ PUGI,IC RECORp.3 RFI,FASF APP FIRM <br /> abed d60:Z0 900Z'11 099 <br />