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REVISM <br /> SAN NTY <br /> JUL 17 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> Teen 1868 East Hazelton Avenue, Stockton, CA 95205-6232 _9H <br /> ENVIRONMENTAL HEAITI�hone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICAN7BUSINESS/AGENCY: <br /> ADDRESS: �'t2�"�`JTt��- �- ��,ly�s( �, r�C 5OC) CITY/STATE/ZILP: WAcA- c44 c114Sci-7 <br /> PHONE (1): PHONE(2): Ui;. 14-1 V-7 ­151 <br /> LS . citfGi. 9`l["S7 <br /> Please allow 10 business days from date of application submittal for the records $vaifablcPny <br /> Staff will contact you to arrange an appointment date and time to review the requilsted records.-11o <br /> CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> vivK:AT vIPE vC ADDLI!`C rAN1 <br /> r <br /> I Electronic Information: E] List ElMap—Description: -`T^` Ni , i / �J, )i ' 1.;' .i C�, �'-i /4 / <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name 74)Gi VV city <br /> 2. g-)3K, Iq 0" , ? <br /> 3. t t S 0ha;�r C L4-_+_0 <br /> .sem <br /> 4. ,�(;'J] ✓y?SD J7. (1 t S` D n u' V `CCCJ <br /> Unit 3 <br /> /6. ; 7!0!!U <br /> 7. ! 4 21 , � o, Aa4, 13� I; d �,re��. � <br /> 81.---> I I)1k �., ,� '3 ! 0 35A kj Z ❑Unit 5 <br /> j 1 , <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ['�UN ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> FX ERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> [21AGOVEGROUND TANK ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL. ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING OICIOMPLAINT/RESPONSE RECORDS ❑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(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 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 /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 4128114 <br />