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EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY � <br /> ENVIRONMENTAL HEALTH DEPARTM54,, <br /> Ulu 600 East Main St. Stockton, CA 9520 3029 ,- <br /> {. e�lephone: (209) 468-3420 Fax: (209) 464-0138 Wel,,,,, sigov.org/ehd <br /> i` ;.;-,�J ��,Ijr--�� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 I •�'� BUSINESS/AGENCY: '�"/1 1 <br /> ADDRESS: S I h-1 S+e 2-Cf) CITYISTATE1ZIP: C-65f ^ I I e C`"C I��2Cp Z <br /> PHONE(1): Cj 0-9 l.P 0� PHONE(2):5i0-6'95-GZ- FACSIMILE: 510-2-q"5- 2(o5( <br /> TENTATIVE"APPOINTMENT DATE: f-Y'Aoj , -Jul`) Z , 2 0) U Time: <br /> (Please allow 10 business days from date of application sub 1-'Tentative only-must be confirmed) <br /> HECK BOX TO EXPEDITE REQ T-$115 SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSI iESS D YS <br /> SIGNATURE OF APPLlCA DATE Q ZS <br /> Electronic Information: 0 List�Map- scription: (2 A U,'1_b41 tAIZ 64VO VY u Q Q 71.37 <br /> FILE ADDRESS4C ite�16 <br /> j EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. 20 l nth S V2 0-t No co <br /> 2 """" Unit 2 <br /> 3. B 50 e u,;�k3 <br /> —4 Unit3 <br /> �t _ <br /> 5. 33-7- i h SI- . <br /> 6. 1 f� 4 f Unit 4 �\ <br /> 7. )50 1 vJ 0.E�1 - n <br /> Flo f l 3 0 �(� I]U n i t 5 <br /> 9. 23 Sfi u5 T' p�5� °�o�y <br /> 10. Unit 6 <br /> Speck Date Range of Information Requested: From U. i C' to r_ s� (�'d <br /> NO ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACiuTYNEHICLE " <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE V 17 <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH RWASTEWATER TREATMENT PLANT 1 <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS <br /> Q(v`" ❑TATTOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: 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)4640138 or mail to the address indicated above. Address <br /> 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 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 /> 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$115 deposit prior to review. <br /> 5. If you need further assistance, please contact Diane Martinez,at(209)468-3425. <br /> END USE ONLY <br /> 3 — N <br /> j �U• <br /> L0 0 -% A I'�42 { L4 , t JC c iV,C c <br />