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t <br /> DATE RECZIy-D <br /> ( <br /> EHD LOG NUMBER Tl���( ��I,�,`�� ���1 SAN .�OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 4 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 We <br /> H�ri,`._i? b: www•sjgov.orgle <br /> s.;, lir.=C1ri PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: � 4 <br /> il�E�E <br /> BUSINESS/AGENCY: <br /> ADDRESS: 5IC� Olin rrft' G l I ""a. <br /> PHONE(1): �`Ftt `.11 PHONE(2): u � <br /> S 75 FACSIMILE- <br /> TENTATIVE`APPOINTMENT DATE: 11 ZZ <br /> (Please allow ton business days from da of a licat su brnl2 . 71ms; <br /> PP Teeretive only-must be cfirmed) <br /> L7 CHECK BOX TO EXPEDITE REQUESTt$986EEP(CASHORC" <br /> INCK ONLY).REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Electronic Information: oust CJ Ma -ID scrlptlon: <br /> FILE ADDRESS EHd USE QNLY <br /> Str�/��t# U —St�ree-t M—am�e— city <br /> 1. 37V�— I IO'miyf• L-Gn� /����nn 0 Unj <br /> 2. �I } <br /> 3. Un <br /> 4. <br /> 5. =d Unit 3 <br /> 6. <br /> 3s� <br /> 7. nit 4Y <br /> 8. <br /> 9. <br /> G Unit 6 <br /> 1 p. <br /> Unit 6 <br /> Specific Date Range of Information Requested:From _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tAZARDOU5 <br /> NDERGROUND TANK(UST)CLEANUP SITE(LDP) a HOUSING ABATEMENT <br /> THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY fi(ASTc <br /> LIO WASTE FACILITYNEHIgI p <br /> UNDERGROUND TANK(MIDNITaRING/REMOVAL) ❑DDG KENNEL TIRE <br /> WASTE GENERATOR ❑DAIRY <br /> ��❑11 TIERED PERMITTED FACILITY ❑CHICKEN RANCH WASTEWATER TREATIAUNT PLANT <br /> •�TATTOo/ooDY PIERCING 0 POOLMOTISPA PUMPER TRUCKfYARDJCHEM TOILETS <br /> Cy POHER(P 1LAND UsE APPLICATION SITES <br /> MEDICAL WASTE FACILITY C3 OTHER(P4EASP.SPECIFY) 1 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVILw - MONDAY-FRIDAY 8:00 AM•$:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above b checkingthe appropriate <br /> box(es). At least one file type MUST be selected, Fax to 2U9 4-0138 or mail to th above <br /> d ress. Addressn <br /> +ts will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <br /> days after receipt of application. The filer.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 the LHD staff may not be immediately available for review. A new application <br /> 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 applicant. <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD49•36 70128lDT <br /> PUBLIC ReCORDS REL E APP PORM <br /> TO I]Jl7d Tb8Z8GLaT8T 8E :80 80OZ/LT/L0 <br />