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NOV-19-2014 WED 02:21 PM KLE1""-T1DER FAX N0, 80')13306 P. 02 <br /> RECEIVED EHD LOG NUMBER <br /> PATE RENOVQ 9 2014 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> azvIAONN ENTALHEA:L� 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERNAVT15�Vl phone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY:_,n,- -F'6e e62 <br /> ADDRESS: p xC7no CITYISTATEIZIP: S cr Ga� c�/Hy� 4rLz <br /> PHONE(1): , PHONE (2): art z !B6® FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> [-] CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CFIECK ONLY)•REQUEST PROCESSED IN 3 13USINES-5 DAYS <br /> SIGNATURE OF APPLICANT A Pr,-e DATE <br /> Electronic Information: ❑ List® Map—Description: r <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> City munIt 1_ <br /> G <br /> 2. 7AAc. unit2 <br /> 3, <br /> 4. mac In / Unit3 <br /> a Cot <br /> ueita <br /> TQC./ A ✓ ^� <br /> 7. e.AR.G}1 <br /> 8• 5 rYS GA2.GN' CLQ Q.Ae- ❑Unit s <br /> 9. <br /> 10 Unit6 <br /> Specific Date Range of Information Requested: From i4LID to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACILITYIVFHICLE <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ®WASTE TRF <br /> ®OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑ <br /> ®UNDERGRDUND TANK(MONITORINGIREMOVAL) ❑FooD FACILITY 0 DAIRY <br /> AD0VEGROUN13 TANK ❑CHICKEN RANCH/DOG KENNEL N WASTEWATER TREATMENT PLANT <br /> ®HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTE-LIHOTEL ❑PUMPFRTRUCKIYARDICHEMIGAL TOILETS <br /> ®TIERED PERMITTED FACILITY ❑POOUSPA <br /> LAND USE APPLICATION SITES <br /> ❑TATTOOIRODY PIERCING ®COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY•FRIDAY 8:00 AM-S:OOPM (EXCLUDING HOLIDAYS) <br /> 1. List .n to ten addressor in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091 464 0138 or mail to the ad ess Indicated above. Address <br /> ranges will not he accepted,Applications received after 3:00 pre 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 HAD files exist. An appointment for review will be confirmed approxlmately ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appolntments <br /> should he 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$130 deposit prior to review. -^BOXEp AREA-EHD USE ONLY-" <br /> ❑ Records provided by Staff-PPR Complete..staff Name: neioUta <br /> EHP ae ae <br /> Received Time Nov. 19. 2014 1 : 34PM No, 7594 <br />