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� vK.- -T, C.rv� v' .iice' a�J rF0, VIdy till�' I NUMEICK <br /> �� ' E SAN JOAQUIN Couary <br /> ZVIRONMENTAL HEALTH Elf=PA <br /> 4A s. rrs -IimoeEast Hazelton Avenue, Stockton, CA <br /> 1A 2 2916 Telephone: 209 468-3420 Fax: 209 464-0138 We vJ isov <br /> ? ( ) rc�lehd <br /> F Iran-qI real :��� E3UBLIC RECORDS RELEASE APPLICATION <br /> APP t. . t3UsINEssIACErrCY: �! r vt �, ,� <br /> ADDRESS: 5' CITYISTATElZlP: Q �{ �{ i <br /> PHO , fay <br /> Please allow 10 bus(rless days fra5rn date of application stlbl�ittal For the records to Eye ava(fa�(e. <br /> Staff will contact you to arrange an appoIntmeht date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List un to ten addresses in the space below. Select the type(e)of files from the list below by checking the appropriate <br /> box(es), At least one file type MUST be selected. Pax to 209 464-0136 or mall to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:.00 (gym will be processed the next business day. <br /> 2. For assistance In identifying the natureand content of FHD records,please contact F-HD at the number noted above. <br /> 3. The EHD will notify the applicant:if any EHD files exist. An appointment for review will be c❑nf(rrTied approximately ten(10) <br /> days after receipt of application, 1 he files viii 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 expanse of the applicant. <br /> Future fife reviews by the same applicant may require a$130 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RFVIEW, MOKIDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS), <br /> Efectronic Information: [] List❑ Map—Deecription: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRbNMEN7AL <br /> HFALTH DEPARTMENT FILE ADDRESS <br /> FILES EH-D USE ONLY <br /> NDERQROUNO TANK(LIST) Street# Street Name city <br /> CLEANUP SITE(LOP) � 1 I� ,(._. �j��..�,i�t - � � LA i CON3UMFR <br /> OTHER CLEANUP SITE(Nora-LOP) V <br /> t?)H.z.-RDaus WA.2-rs /�yi a T - Dalar <br /> �TIERED PERMITTED FACILITY 2 t+�S(� .{�� 1 ]Q ��� �j <br /> y-1 ABOVEGROUND TANPC f {{ N' <br /> 1---+UST(MONITORIN©l RVAL) s I <br /> kiauaDOUs IuiArl:Rws , S•03 ��<0 <br /> SPILL/RELEASC RE,r.PON:E <br /> . <br /> SOLID WASTE FACILITY/VEHICLE G WATER❑UALrrT <br /> Q rOOD FACILITY <br /> POOL/SPA [''Sr'(E MITIGATION <br /> DA1siY C - <br /> LAHD USE APPucarloN.S7><S -- <br /> SEPTIC PUMPER TRUCK/ 5 ❑Ha�iuc <br /> YARD/CHEMICAL TOILETS <br /> }��/ / <br /> iJ6 WASTEWATER TREATMENT PLANT <br /> Cg COPA <br /> l❑"1,HOvSMGA6ATEMENT 7 <br /> MOTEFJHOTEL / <br /> CHICKV4 RANCH/DOG KENNEL fLIPA/ -HAZ.-MAT <br /> a <br /> r]MEDICAL WASTE FAVLITY <br /> TATTOOIBODY PIERCING <br /> WAsiE TIRE y <br /> %[D Wfi STECOMPLAWT <br /> E]OTHER(PLEAUE SPECIFY): CCOONTINC <br /> ''BOXED AREA-EHD USE Ot&Y— <br /> r< CO Lb 5 cap <br /> ?3 lU <br /> Receive4-TimeRMa>, 2. . _ 1 I �- 48PGiNo, - �4Staff Name; <br />