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11/LU/•LUUU 1b :28 San Joaquin County —> 4640138 2 <br /> 5-44\ <br /> REC IVf�p I EHD LOG NUMBER <br /> 50 `' .=_j � SAN JOAQUIN COUNTY <br /> 1'4UV i �nCIJ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Tlephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/e <br /> J�) PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; 1/ERR�a' ������ BUSINESS/AGENCY: <br /> ADDRESS: 44 N , SnN , .STr 3< CITY/STATE/ZIP: <br /> PHONE(1): (,,2yq) PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Dt=c 4 aUrj`f Time: Iy cw <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQ ST-$115 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF API DATE Nov )q, goo y <br /> Electronic Information: ❑List[] Map—Description: <br /> FILE ADDRESS EHD USE ONLY G. <br /> Street p Street Name A N Unit 1 <br /> CgCity <br /> 1. ------- ---P � <br /> _ ii,.�r��/ CL�t(��iv a -.t to•o srot.Kron/ <br /> 2. 3A_ [_111 F1r,P,9.5A RD. 173-o(•o 3,. °LL�[2_ J lllltl�� <br /> 3' .�4�g _rrr[.< n��� LN U45 •rio-•I l_ovi S.T C.'�%.5��i,�JU.y]�1 \ <br /> /3975 G. Hwy 8A UI'T�0 n-f1 I_n�.KrFor21> �Su .� Unit <br /> 6- 3`•i N.CHGe0e6:C LN <br /> o43 f o0i Looj la 5 �b <br /> 6. 4-o 1 _n1 5 1 o r? j r� 1 — -- e;7 t G1/� 7 nit 4 <br /> 7. ---1 <br /> 8. <br /> _._ ❑Units <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Informatlon Requested: From to (' (t p[:/J( <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I�S � <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT []SOLID WASTE FACILITYNEHICLE l <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINOIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ®HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT zI� <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEMICAL TOILETS ) / <br /> TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑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$115 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468.3426, <br /> EHD USE ONLY <br /> _O <br /> 6/5 <br /> EH048-08 I (ten <br />