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CSAN JOAQUIN COUNTY � CD <br /> NOV Zi}14 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205 6232 �1 <br /> TTbne: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> EtSVPERMITISEhgI <br /> A , UBLIC RECORDS RELEASE APPLICATION x <br /> APPLICANT: rf itG BUSINESSIAGENCY: <br /> ADDRESS: L12o -WI- )nS¢� _C: ' ,,tv�'__ CITY/STATEIZIP: � v���`"� �[ �{ c(533 � <br /> PHONE (1): j��L q III PHONE(2): FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange IaIn�77appointment date and time to review the requested records. <br /> F1 CHECK BOX TO EXPEDITE rREE9,UOT-$IArFEE(CAS ECK ONLY)-REQUEST PROCESSED IN 3 BUSINE- S DAYS <br /> SIGNATURE OF APPLICADATA / <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city �,,Z Unit 1 <br /> 1. 2.D oSPi ° l�lRw of IM us ytir+��lC^ rp <br /> 2. �P �mrimn� <br /> ❑ Unit <br /> 3. rr <br /> 4• Unit 3 �1 <br /> 5. <br /> 6• nit4 <br /> 8• ❑Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILES <br /> LRLUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE 05 <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT El WASTE TIRE y <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) gFOOD FACILITY ❑DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT 17' <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEUHOTEL ❑PUMPER TRUCKNARD/CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING [ZCOMPLAINTIRESPONSE RECORDS ❑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)464.0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 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 /> 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$125 deposit prior to review. 'BOXED AREA-EHD USE ONLY' <br /> 1-2--j-10 D-Z , 1AJZA rcp�jo Vie -. 'bt <br /> RQ �-' U51- C ) <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 4128114 <br />