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DATE RECEIVEDEHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ' `~ <br />€ { j ��% �'I I,� ��IIJAi ENV ONMENTAL HEALTH DEPARTYNT <br /> j <br /> AUG 4 � �� 600 East Main St. Stockton, CA 95202=2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e <br /> 7 VZ <br /> ENVIR0IM'dENT HEALTH I <br /> PE�V!"rlYEPKK PUBLIC RECORDS RELEASE APPLICATION° <br /> I, APPLICANT:s (Z's t j - r' i L�� 2j ,I.'t'� b k-00 I(- L y BUSINESSIAGENCY: <br /> ADDRESS: CITYISTATEIZIP <br /> PHONE(1): — PHONE%"_(QfG- %;Z FACSIMILE: "9 qg _ D <br /> TENTATIVE"APPOINTMENT DATE: ii Time: <br /> (Please allow 10 business,days from date of application submittal-'Tentative only-must be confirmed) <br /> © CHECK BOX TO EXPEDITE REQUEST-$105.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> I SIGNATURE OF APPLICANT DATE CVIS-10S <br /> Electronic Information: ist❑ Map"—Description: I <br /> FILE ADDRESS = EHD USE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> �. � . W <br /> 2. ❑ unit z <br /> 3. <br /> 4. <br /> Unit 3 <br /> s. Polnit 4 <br /> 7. <br /> ❑ Unit 5 <br /> 8. <br /> 9. • <br /> ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> IT <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT © SOLID WASTE FACILITYNEHICLE <br /> HER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL © DAIRY <br /> AZARDOUS WASTE GENERATOR CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERIAITTED FACILITY ❑MOTEL/HOTEL " PUMPER TRUCKIYARDICHEM TOILETS <br /> M TATTOOIBODY PIERCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 6 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)4640138 or-?mail td'.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 notifythe applicant if an EHD files exist. An <br /> pp y 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 reviewA new application may be <br /> submitted when the file Is available. <br /> i <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$105.00 deposit prior to review. <br /> EHD USE ONLY <br /> ***If you need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You*** <br /> I� <br /> EHD 4806 8104!2008 <br />