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• D <br /> DnrrlvC SAN .IOAQUIN COUNTY EHD LOG NUMBER <br /> •v Z��� ENVIRONMENTAL HEALTH DEPARTMENT <br /> NAV 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> IWlabne: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> Ce8 PUBLIC RECORDS RELEASE APPLICATION <br /> , — 22 <br /> APPLICANT: BUSINESS/AGENCY: <br /> ADDRESS: fJ,�'VP . N J3 CITY/STATE/ZIP-A0 64rA�64- 7C'-?'5' <br /> PHONE (1): f/^��($�- ?3(() Ul PHONE(2):�W go f-NOS'-33fS1 FACSIMILEa09'-.Y°/S' 7S 3 "rX <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 f3B'F (CASH O ONLY)-REQUEST PROCESSED IN 3 BUSINE S DAYS <br /> SIGNATURE OF APPLICANT DATE 7 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 2. o4k.0 a g5aZ3 Cr ❑Unit2 `� <br /> 3. � t� � <br /> 4. Unita rJoor <br /> (� <br /> 5. CI <br /> 6. ❑Unit 4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From UP3r rPZeJ �'�[Ie <br /> S to <br /> ENVIRONMENTAL EALTH DEPARTMENT FIL_ S �,� Z <br /> F-1n�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY SOLID WASTE FACIILITYrIVEHICLE <br /> ❑OTHER CLEANUP SITE(NON•LOP) ❑HOUSING ABATEMENT c ASTE TIRE <br /> ❑UN�DERGROUND TANK(MONITORINGIREMOVALb( ❑FOOD FACILITY AIRY <br /> ❑/13 EGROUNDTANK V. ❑CHICKEN RANCHI DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> Fe�HAZARDOUSWASTEIHAZARDOUS MATERIALSO`' ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICALTOILETS <br /> I✓ 1IERED PERMITTED FACILITY N ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> TATTOOIBODY PIERCING t/COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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 /> 3 ---Vg o3ok 6,to qvt <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 4128114 <br />