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c, r; EHD LOG NUMBER' <br /> DATE RECEIVED <br /> _ SAN-JOAQUIN-COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 <br /> Telephone:(209)468-3420 Fax. (209) 464-0138 Web: www.sjgov.or <br /> �h <br /> PUBLIC RECORDS RELEASE APPLICATION �/ <br /> APPLICANT:-° II ��I.L GL. �c-LxXf BUSINESSIAGENCY�s-/1�..Y a-'7�Gja: - CZC <br /> ADDRESS: 1 5 i G S Z�' r" " CITYISTATEIZIP 04-iC & -d. � Z_ - <br /> PHONE(1): SIa �)Z 2- 2,16c) PHONE(2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> 1:3 CHECK BOX TO EXPEDITE REQUEST•$105.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br />' Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br />{ <br /> 2• g-701 rW bon LL) r r 5-r1) OEs 1 h ❑ Unit 2 <br /> I 3. '770 .Tarn Sl 5 <br /> Lh <br /> 4. Y5-0 N C -vr� CSL_ a y-r LOD (9 C-5 nit <br /> 5. '� <br /> 6. � Unit 4 <br /> 7. <br /> 8. ❑ Unit 5 <br /> ❑ Unit 6 <br /> 1 D. <br /> Specific Date Ran of Information p Range Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES r <br /> {' NDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ZY) C7 FOOD FACILITY 0 WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL 13DOG KENNEL 0 DAIRY <br /> .�HAZARDOUS WASTE GENERATORt �� 0 CHICKEN RANCH C3 WASTEWATER TREATMENT PLANT 1 3�3fo� <br /> TIERED PERMITTED FACILITY]k P, 0 MOTELIHOTEL 13 PUMPER TRUCK/YARDICHEM TOILETS 1 <br /> Q TATTOOIBODY PIERCINGt< <br /> 0 0 POOL/SPA LAND US PPLICATION ITES <br /> I7 MEDICAL WASTE FACILITY 0 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RENEW - 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 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 /> f ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review wili 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 /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file Is available. <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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance Please contact Diane Martinez a (209)468-3425 directly. Thank You*** <br /> tea- )qV0dejgC 9 O GAJ <br /> rZHD 4"6 <br />