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�e U I I rlVl ) No. 169J EhN- IG NUMBER <br /> 'am SAN JOAQUIN COUNTY <br /> EN1i NmENTAL HEALTH DEPAPTMENT <br /> SEPT0 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ( c� <br /> a@9 15 t It,, r6 <br /> V. <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.or e lE��`iR0N[AENTAL HV,LTH �' I E Cu . <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: A-5kb Li'l Yl ►S�` BUSINESS/ GE[ Cl':Sj GDU,I1 1 pub/ <br /> r"+,vuRESS: It 3,-A �_ .{o{G•I 't��.tl l I tV�i' CIT'YSTATE/ZIP: S i� � `��?'Dr <br /> PHONE (1): C2,M) LJlA, —30SS- PHONE(2): FACSIMILE: 10) Y'09— V4 C91 � <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 GCSH��O%%R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTQ� rlC e' '� DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> Street# Street Name City EHD USE ONLY <br /> I <br /> 2. 32(p3 av wW C� S c,IG�Dn (]'unit 1 <br /> 3. 3L� GIS <br /> It <br /> un2 <br /> $ 3y3 Z ' CV Q-'W k-a Cn�WZA f._. EF) LYSv1� - Unit 2H <br /> 51 qh-yv at k c1 A C &_P)d LWl-YF7 I i I �I 1 t <br /> I 6. ?ju(0 n j� k S'tv uG�h L1 "I5! Ir sod CD-Unit 3 e <br /> 7. M/U it 4 <br /> 8. 2 <br /> 'slTe MrncATlaN <br /> . �� 69e <br /> �— <br /> i v. !�") , ► "(max- 1✓f 1 UT" T 'Unit 5 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ,MEDICAL WASTE FACILITY SOLID WASTE FACIL1 YNEHICLE <br /> OTHER CLEANUP Srm(NON-LOP) _T>ffHOUSINS ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY DAIRY <br /> ,1ABOVEGROUNDTANK CHICKEN RANCH(DOG KENNEL WASTEWATER TREATMENT PLANT <br /> N{AZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTEUHOTEL PUMPER TRUCKIYARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY POOLISPA Z.,LAND USE APPLICATION SITES <br /> ❑TATToOIBODY PIERCING 19COMPLAINTIRESPONSE 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 flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)484-0138 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 approgimately 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 fife not returned In the same condition as released will be reorganlied 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. `BOXED AREA-EHD USE ONLY` <br /> r 1 E?or�rrac �rr.,.e<Ie.t IDtf cf�f`-otzo r'Q.,.,...s..4'„ Staff Name: <br /> Received Time--Sep. 17, 2-2015_ 3; 08PM=No. 9598 <br /> EHo 4s-06 T!1/15 <br />