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(o I���LSD AN JOAQUIN COUNTY rnU LV�NVMCtK <br /> u U EC LU J D ENVIR(�_ � ENTAL HEALTH DEPARTMENO <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708ZL5735 <br /> kI ' 7 LHOAelephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehENVIRONiw;EN' 11 rn $ <br /> �� UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> /' rt < \ <br /> ADDRESS:_�Iq tl C �� QrQ BUSINE�SI�SIAAGGENNC�Y:1 <br /> PHONE(1): �Yj� Z( O <br /> 2 — f Tr C-'R PHONE 2: CITY k (�-�STATE HT) <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-•TenfaUve only.Time:_ <br /> E3 CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE{GASH CHECK ONLY)-REQUEST PROCESSED IN DAYS <br /> SIGNATURE OF APPLICANT <br /> Electronic DATE <br /> Information List '] Map-Description <br /> FILE ADDRESS <br /> Street it Street Name <br /> 1• 5 o uc city EHD USE ONLY <br /> 2. S C_ <br /> 3. =k: ❑ Unit 1 <br /> 4. <br /> S. ❑ Unit 2 <br /> �; Unit 3 3��7 <br /> 9. - yo B'UM4 <br /> 10. ❑ Unit 5 <br /> Specific Date Range of Information Requested: FromElUnit 6 <br /> t450 to 6-crrreAf- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) <br /> yar3 �OMER CLEANUP SITE(NON-LOP) E3 HOUSING A13ATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> 3�,,e .V�.�N�DERGROUNO LANK(MONITORINGIREMOVAL) 0 FOD FACILITY 0 WASTE TIRE <br /> 'I"r1AZARDOUS WASTE GENERATOR DO KENNEL ❑ DAIRY <br /> 0 TIERED PERMITTED FACILITY CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> O TATTOOIBODY PIERCING 17 MOTELIHOTEL E3 PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> 0 MEDICAL WASTE FACILITY 0 POOLISPq ❑R(PLEASE SPECIFY) LAND USE APPLICATION SITES <br /> L <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR EREVIEW -MONDAY-FRIDAY 8:00 AM-5:00PM <br /> - EXCLUDING HOLIDAYS. <br /> I. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the <br /> appropriate bOX(es). At least one file type MUST be Selected. ax to (209)464-0138 or mail to the address <br /> Indicated Address ranges will not be accepted—for addltlonal assistance with Me addresses,contact <br /> the EHD. Applications received after 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 <br /> approximately ten (10) days after receipt of application. The files will be held fora maximum of five business <br /> days for review. Appointments 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 <br /> application may be 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 <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> n, <br /> 4 <br /> END 4806 J <br /> 10131n006 <br />