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REOFIVEb <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> JAN 13 2015 ENVIRONMENTAL HEALTH DEPARTMENT o I 1 6 <br /> 1 68 East Hazelton Avenue, Stockton, CA 95205-6232 l `J <br /> Telephone: (209)4.68-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES - PU LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ;&"ArJNS 1��S �GY T1,1BUSINESS/AGENCY: <br /> ADDRESS: Z� �� TLS �S T � CITY/STATE/ZIP: _94L L7YJ (f Gf SSS-69 <br /> PHONE (1): 5�D ?j(�j7 6� PHONE (2): FACSIMILE: <br /> Please allow 10 busin ss 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 /> ECK BOX TO EXPEDITE EQU -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SI NATURE OF APPLICANT EST- z�rASH�01C=KONIUY) DATE <br /> Electronic Information: ❑ Li t❑ Map—Description: <br /> p- FIL ADDRESS EHD USE ONLY <br /> o(Y' Street# S reet Name City <br /> ❑Unit 1 <br /> .., 1• 1��3 C a ll��4�. 1r�,�c� �`,�` <br /> J 2. AJ ir <br /> JI ❑Unit <br /> 3. <br /> 4. <br /> Unit 3 <br /> 5. <br /> 6° Unit 4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> E]Unit 6 <br /> 3—►5 <br /> Specific Date Range of Information Requ sted: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES bj file <br /> 1DERGROUND TANK(UST)CLEANUP SIT (LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE rjy-Ij t1 <br /> [OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ❑LIUNDERGROUND TANK(MONITORINGIREMO AL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> 'HAZARDOUS WASTEIHAZARDOUS MATER] LS F-1MOTEL/HOTEL ❑PUMPER TRUCKNARD/CHEMICAL TOILETS �1 <br /> ❑TIERED PERMITTED FACILITY ❑P OLISPA ❑LAND USE APPLICATION SITES <br /> F1TATTOOIBODY PIERCING [ MPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORD ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the sp ce above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MU T be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Appl cations received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the ature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant i any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. he 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 ondition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same a plicant may require a$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> 1-13_15 0"� k ys 4orAky— PKQ.Uel Ln �ti-k Zr4nr,. ,9.rkra�,-kw,, UN �,A PV� [V, <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 4/28/14 <br />