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� ��„�'�y.^,Jg.�•�'Ga.,a t -_ + --. ,a ., - � . -.-+4 d -...� a-.��P l� i i 71 Fr It'. <br /> Q. <br /> rq <br /> _R .5 S+w <br /> .,,.,•�4�tu r!b,:=t''�'[�4 311����� _ �1\ f.aitLl\1►'11�.f1��,t11J�111tTL11� �L'Pli[\LLr1L'i� - .. .. ..i9,:,...,, <br /> 304 East Weber Avenue, 3j Floor, Stockton,CA-95202-2708 <br /> jb6 Telephone: (209)468-3420 Fax: (209)464-013&Web:www.sjgov.org ehd <br /> V6RaN N� K AS19 <br /> I I . 'PUBLIC RECORDS RELEASE APPLICATION <br /> WAI <br /> APP . ANT: BUSINESSIAGENCY: <br /> ADDRESS• SL C e u\ <br /> PHONE(1): 2 0 9'`.S(Dq`.SSI�o PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tenfafive only-must be confirmed) <br /> © CHECK BOX TO EXPEDITE UES:FEE{CAS I OR CHECKONLY)—REQUEST PROCESSED'IN 3 U$INESS DAYS <br /> ZIGNATURE OF APPLICANT DATE gt�� <br /> UNIT DISTRIBUTION 0 Unit 1 E3 Unit 2 Unit 3 Unit 4 Unit b Unit G. Other(electronic/listslmaps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Street Name C1 y <br /> 1. WC' t, YIN 13'0/ <br /> 2. /lol <br /> 3. <br /> 4. <br /> 5. <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q JNO TANK(US7}C�EAIjUP SITE(LOP) HOUSING ABATEM C3 SOLID WASTE FACILITYNEHICLE <br /> [3 <br /> R GROtU"MCLFJWUP SIZE(Nora-LOP) E3F000 FACILITYE3WasTe TIREf <br /> GROLINO TAHK(MONITORINGIREMOVAL) 0 Dor.KF.mEL Q DAIRY <br /> ❑HAXA mus WASTE GENERATOR O CIfCKeN RANCH ❑WASTEWATER TREATmEuT PLANT <br /> t❑TIERED PERMITTED FACILITY ❑MOTELMOTEL M PUMPER TRucrJYARDrAEM TOILETS <br /> 10 TATTOoIBoDY PIeRciNG d POOLISPA 0 .AND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACiL ITY C3- 1 d HERP1.EASE S_ _FY <br /> - <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAMSLE FOR REVM- MON MY-FRIDAY 8:00 AM-5:00PMt - EXCLUDING HOLWAYS.- <br /> 1. List up to ten addresses In the space above. Select the.type s)of files from the list above by checking the <br /> appropriate box(es), At least one file type MUST be selected. Fax to(2091464-0138 or mail to the address <br /> indicated above. Address ranges will not be accepted—for additional assistance with file addresses,contact <br /> the EHD.Applications received after 3:00 pm will be proces ed the next business day. <br /> 2. The EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately ten (10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments 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 <br /> application may be submitted when the file is available. <br /> 4. Any fete not returned in the same."ndition as'released will he reoManized by iFJiD sW at the expense of the <br /> applicant. Future file reviews by the same applicant may require a$93.00 deposit.prior to review. . <br /> fr-•• it�S1 i`. <br /> 3r'--til�v!'•s t4 '�L <br /> EHD 48-02-M <br /> 11123104 <br />