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WL-41 15 13:St 1lhum— T-501 P001/001 F-788 <br /> ■ UA It Kt U LNU LUIS NUMtItK <br /> l�■ SAN IOAQUIN COUNTY <br /> ■ ENVIRONMENTAL HEALTH DEPARTMENT <br /> li 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �ephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> Ovvm NMF <br /> N7,-4L PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: / t BUSINESS/AGENCY:.1 �P �i'6U1J <br /> ADDRESS: CITY/STATE/ZIP: l ( a, <br /> _ ext �1: <br /> PHONE (1): ��t� R1.�;—` �, jPHONE(2):��I�".L ���j 3�(� FACSIMILE: qqj 6gni- t4jj, <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 REO T-11 0 FEE(C H 4R CHECK ONLY)-REQUEST PROCESSED IN 3 B SINESS DAYS <br /> SIGNATURE OF APPLICANT i/ DATE [ .� <br /> Electronic Information: ❑ List❑ Map—De ription: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑unit 9 <br /> hA <br /> 2' 1g l7D ..%& 1V(-,t` ❑ Unit <br /> 3 <br /> El Unit 3 <br /> 6. 01 iinIt 4 <br /> 7. R,-,W 5 <br /> 8. <br /> _ 0 Unit S <br /> 9. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑S ABOVEGROUND TANK ❑CHICKEN RANCH]DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEMA7.ARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHE=R(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 13:00 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 mall 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 $130 deposit prior to review. "`*BOXED AREA-EHD USE ONLY` <br /> Lr,w..-tek M #6r Ak I w 4e G'I �1 � �� �v^ �►t ��le 1e l�W� <br /> ❑ Records provided by Staff-PPR Complete, Staff Name: <br /> EHD 46-06 <br /> 08101/14 <br /> Received Time Feb, 27, 2015 1 :31PM No. 8231 <br />