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bA'TE REC;EIV p <br /> rl I�•, <br /> c ` j `� �L ! SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> t. 12 1 1009 600 East Main St. Stockton, CA 95202-2708 <br /> 'Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.or I <br /> EN F,0N'i'VICEI •' r�LAL1H <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Flo I---dp^ir BUSINESSIAGENCY: <br /> ADDRESS: �� K ('q1 ZO 2— CITYISTATEIzIP 57 4G_ -hTY, <br /> PHONE(1): Zaq - $ "7 - 52 3 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 /> CHECK BOX TO EXPEDITE REQUEST-$105.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT &7-_ — Af DATE 7_ 2—`— OF <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Flame <br /> City ❑ Unit 1 <br /> 1. (,,'1 <br /> ��f —�A c&k .S e- L c. � � IU P <br /> 1'! 2. l a' r7—7 o uJ �i �O�ir © w '5'i6t �_r� { 'C 2 <br /> 4. c'Unitt3 6. <br /> 5. - <br /> 6. 6nit 4 <br /> 7. <br /> 8. <br /> Unit 5 <br /> 9. <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> C3 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) KXHOUSING ABATEMENT © SOLID WASTE FACILITYIVEHICLE tk-� <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY 13 WASTE TIRE <br /> UNDERGROUND TANK(M ONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> �iHAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH a WASTEWATER TREATMENT PLANT <br /> d TIERED PERMITTED FACILITY CI MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING d POOLISPA 11 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) /C <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 209 464-0138 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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> If you need further assistance please contact plane Martinez @ (209)468-3425 directly. Thank You*** <br />