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04/28/2010 11:51 510655 '7 ENVIRON PAGE 02/02 <br /> o �i <br /> ��,��Fn) SAN .1OAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> R �` 600 East Main St. Stockton, CA 95202-3029 <br /> APP, 2` 8 �U u Telephone: (209)468-3420 Fax: (209)4.64-0138 Web: www.sigovi.org/ehd <br /> ENVIRONMENT Hq pc N PUBLIC RECORDS RELEASE APPLICATIO0. <br /> P F W 4!E�- <br /> APPLICANT: -Aa�.I �p BUSINESS/AGENCY: LN Vgok� <br /> ADDRESS: �QQ� S11�11�(U���d1`1!� � �1�C~ �� CITY/STATEIZIP:LNq2�1tI U� E.lCA 14 " <br /> PHQNE(1): - 5C) PHONE(2): FACSIMILE: (5LO S_s <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT C�iaG1Cl.Cd a -- "DATE 14-2S 2010 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street tf Street Name — City Unit 1 <br /> _ ...------- <br /> 1. <br /> 4. , <br /> ---- nnit <br /> 6. <br /> 7. <br /> ,.8` _ ..,,..... ._., ..- _ — -.... ❑Unit 5 <br /> 9. <br /> 10. <br /> Unit B <br /> 5peclfic Date Range of Information Rcqucsted: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHICI,F, <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITOR)NGIREMOVAL) ❑DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR [)CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY MOTELIHOTEL RPUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOI,/SPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY E]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM 5:00PM(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 file type MUST be selected. Fax to 09 464-0138 oF mail to the add ass 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 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. <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,phase contact Diane Martinez,at(209)468-3425. <br /> EHD USF ONLY <br /> F-HD 48-00 8127109 <br />