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SAN J OAQUIN COUNTY <br /> ENNOONMENTAL HEALTH DEPART <br /> 000 East Main Street, Stockton, CA 95202 L� I <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov dTI <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: D t• NJ aJ, �`a.— BUSINESS/AGENCY: AW <br /> ADDRESS: '-' N' Gy��"^ S�G%4- Tj�VC1,, rf C � j, Vk-C(L C14 'IS 38 Z <br /> PHONE(1): Zo5 G67 - FJ Ti PHONE(2): 'Mt 4401L-(-+'b - 74-57 FACSIMILE: ZA9 (otO T 4(oto 0 <br /> TENTATIVE*APPOINTMENT DATE: �3 f3 O r Time:_1'0O� <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT D1*— DATE <br /> Electronic Information: ❑ List❑ Map- Description: <br /> FILE ADDRESS —€H, E ONLY <br /> t / Street# Street Name city I,t <(y 1 ❑ Unit 1 <br /> (20(a /�G+t1n ( pAt StsC((kpn �(� 01 Cbt o♦ S ❑ Unit <br /> \\V� 3. <br /> 4. Unit 3 <br /> 5. <br /> 6. - - - - Unit \� <br /> 7. <br /> 13 - ❑ Unit 5 <br /> 9. _ <br /> -- -- -- --- <br /> El Unit <br /> 10, <br /> Specific Date Range of Information Requested: From ZaakA to (J tVAN�- <br /> X' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> R9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHICLE <br /> 0 f.1THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑WASTE TIRE <br /> (UNDERGROUND TANK(MONITORING/REMOVAL) 13 DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Cl 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-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$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 46-06 5/162007 <br />