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RftEIVED <br /> 0 <br /> DATE RECEIVED EHD LOG NUMBER <br /> DEC. 3 2014 SAN J®AQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> E R®N ENT�I1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> N L , <br /> PER ITENTALC S lephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECO S RFLEASE APPLICATION <br /> APPLICANT: 11 6'r -0LI <br /> USINESS/AG ENCY: (--� <br /> ADDRESS: �'�XiL CITY/STA E/ZIP: I n c ( C.0 <br /> PHONE(1). e PHONE(2): FACSIMILE: <br /> PWase allow 10 busi6ess day`s from data of application submittal for the records to be available. <br /> Staff will contact you to arrange an aptmen date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$1 CAS CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS D YS <br /> SIGNATURE OF APPLICANT DATE ` <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE LY <br /> Street# Street Name city ` 1 ✓� <br /> �114 q3-7 <br /> 6Z r��lC� I e a k.n t$ '`nI <br /> e2 511� 5(iZ,3w o,0 /jll t (y 'nit 3 t <br /> 5 ( 2 Go n� rhAl `�� ® j.r3 Lo <br /> � <br /> 6. � �^ )jq 01 nit <br /> 4 <br /> 6) i 5 r oj do OA UA <br /> M' 1A. (i ktit / -ea(�i ❑ Units <br /> 9. <br /> 10. <br /> . El unit s <br /> Specific Date Range of Information Requested: From 7D 17 to <br /> f ENVIRONMENT L HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> �HAZARDOUS WASTEIHAZARDOUSMATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES�7 / <br /> [:1TATTOOIBODY PIERCING ZOMPLAINTIRESPONSE RECORDS \Z ,OTHE^"'LEASE SPECIFY) rl j� 6'7 4l S <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAY94 <br /> 1. List unto 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(209)464-0138 or mail to the address indicated above. Address W sz- <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <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. <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$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> 7n <br /> ❑ Records provid d by Staff-PPR Co plete. Staff Name: <br /> EHD 48.06/ `� /� ��94/28H4 <br />