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EHD LOG NUMBER <br /> DATE L%CENV D <br /> SAN JOAQUIN COUNTY <br /> ED <br /> REG ENVIRONMENTAL HEALTH DEPARTMENT <br /> I s F 1868 East Hazelton Avenue,-Stockton, CA 95205-6232 <br /> -P 17 Z015 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwW.sj90V-Org/ehd <br /> =,W Rio N M ENTAL H VEM PUBLIC RECORDS RELEASE APPUCAT ION <br /> Bus, <br /> CITY/STATE/ZIP:L cL <br /> ADDRESS: R-1" --4' ) &f—C-;-2-� <br /> FACSIMILE: a-7:) <br /> PHONE (i): PHONE(2): <br /> Please allow 10 business days from date of application submittal forthe.records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> FtCHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT— DATE <br /> Electronic Information: 0 List 0 Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> vu-it 1 <br /> 2. F-P,COO 7 00 1- F1 Unit 2 <br /> 3. po I-Z-2-63?7 <br /> El Unit 2H <br /> 5. 0 Unit 3 <br /> 6. <br /> 0 <br /> E]Unit 4 <br /> 7. Unit <br /> [:]:S:I:TE MITIGATION <br /> 8. <br /> 9. <br /> — Ej Unit 5 <br /> 10. <br /> to <br /> Specific Date Range of Information Requested: From ------------------- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITYNEHICLE <br /> F]UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 MEDICAL WASTE FACILITY <br /> ❑ <br /> [_1 HOUSING ABATEMENT F-1 WASTE TIRE <br /> ❑OTHER CLEANUP SITE(NON-LOP) SLFOOD FACILITY ❑DAIRY <br /> F-1 UNDERGROUND TANK(MONITORINGIREMOVAL) CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> F-1 ABOVEGROUND TANK MOTELIHOTEL PUMPER TRUCK]YARDICHEMICAL TOILETS <br /> F-1 HAZARDOUS WASTE]HAZARDOUS MATERIALS ❑El POOLISPA LAND USE APPLICATION SITES i7n <br /> F-1 TIERED PERMITTED FACILITY ❑ <br /> COMPLAINTIRESPONSE RECORDS OTHER(PLEASE SPECIFY) A_eZn1-4'1 I <br /> F-I TATTOO/BODY PIERCING ❑ <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AMr5:00PM (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 tile type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next businessday. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br /> 3. 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. be reorganized by EHD staff at the expense of the applicant. <br /> 4. Any file not returned in the same condition as released will o review. ***BOXED AREA EHD USE ONLY" <br /> Future file reviews by the same applicant may require a$130 deposit prior t <br /> El Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48706- <br />