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DATE RECEIVED • • EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-2708 / 1 3 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.or�gp'� J (/7 <br /> ` �P`UBLIC,� RECORDS RELEASE APPLICATION // ,) <br /> APPLICANT: 016" - - u/ K. �C �C X1� BUSINESS/AGENCY4-i;LY a'AltLX�y <br /> ADDRESS: 1'5/ 5 0�� 5 f Z �n'f -f/ CITYISTATEIZIP 0-t i-' 66L' C� t 7l t./ Z_ <br /> PHONE(1): 90 W Z- ZI�'G 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 /> E3 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 /> 2. r G ( LU:�SCht LLis I / a5 T(z) OEs i Nu Loth El Unit 2 <br /> 3. -7 -7C0 TUr✓t L jlto ! S' S <br /> 4. y�_U N _ Chi tr, (� ofz u5T 0 UCSplinit5.6 <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES f <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY/VEHICLE S IC <br /> OTHER CLEANUP SITE(NON-LOP) 7 Cl FOOD FACILITY ❑ WASTE TIRE <br /> UNDERGROUND TANK(MON[" ❑ DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATORS ve ❑ CHICKEN RANCH 17 WASTEWATER TREATMENT PLANT -3/3/fk <br /> TIERED PERMITTED FACILITY At( _(y.i\ 13 MOTELIHOTEL El PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOIBODYPIERCINGb< •1 oV 1 ❑ POOLISPAC(LANDUSf��1PPLICATION ITES <br /> ❑MEDICAL WASTE FACILITY t7 ❑OTHER(PLEASE SPECIFY)` �X\(5 i � <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 /> 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 Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> ( -Ig 9 6v ; <br /> END 4s-0s <br />