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APPLICANT: Afa. v e vl S e <br />ADDRESS: <br />PHONE (1): — PHONE (2): <br />SIGNATURE OF APPLICANT <br />FAX OR E-MAIL: 'cal (I/Seri-4 709 <br />Please allow 10 business days from date of application submittal for the records to be adailable. Pce, <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />0 CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />DATE /2-- 7------- /6- <br />BUSINESS/AGENCY: aeiAefrA's <br />CITY/STATE/ZIP: <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />EHD LOG NUMBER <br />vivo <br />PUBLIC RECORDS RELEASE APPLICATION <br />Electronic Information: LI List Map — Description: <br />FILE ADDRESS <br />EHD USE ONLY <br />Street # Street Name City <br /> 227 2 5 CA (› I, Pc (411-6) "pr e <br />nit 1 <br />cov, Pc)• ,--e <br />i-let.,, 1 <br /> <br />'-(-11-0\-- <br /> <br />7_ ot 0 6 eVotot- <br />35-1`, AUCUI d 9 (Llifi/t 0 ti-- , - P 6)-12 D Unit 2 <br /> El Unit 2H <br /> 1:1 Unit 3 <br /> <br />-,( 2,0 (.5— Ei Unit 3HM <br /> <br />- El Unit 4 <br />El SITE MITIGATION <br />Li Unit 5 10. <br />Specific Date Range of Information Requested: From <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />0 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) LI MOTELJHOTEL <br />0 OTHER CLEANUP SITE (NON-LOP) El HOUSING ABATEMENT <br />0 UNDERGROUND TANK (MONITORING/REMOVAL) 0 WASTE TIRE <br />0 ABOVEGROUND TANK 0 CHICKEN RANCH/ DOG KENNEL <br />El HAZARDOUS WASTE 0 MEDICAL WASTE FACILITY <br />0 HAZARDOUS MATERIALS 0 TATTOO/BODY PIERCING <br />0 TIERED PERMITTED FACILITY 0 COMPLAINT/RESPONSE RECORDS <br />0 SOLID WASTE FACILITYNEHICLE <br />El FOOD FACILITY <br />-DAIRY, POOL/SPA <br />El WASTEWATER TREATMENT PLANT <br />0 PUMPER TRUCK/YARD/CHEMICAL TOILETS <br />LI LAND USE APPLICATION SITES <br />0 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORpS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />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 />For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted above. <br />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 />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. <br />***BOXED AREA - EHD USE ONLY*** <br />((/ d Dcl Cut <br />PO-- P - -c-c-is ks,,--,IL f,)Cct- . - ' • - - <br />Records provided by Staff-PPR Complete. Staff Name: f <br />to