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� k <br /> RECEIVED -� <br /> EMD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> p <br /> . FSB G 3 2012 ' . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> EMIiRONMENTAL HEALTH 600 East Main St- Stockton, CA 96202-3029 <br /> PERMIT/SERVICES Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> i. <br /> PUBLIC R CORDS RELEASE APPLICATION <br /> APPLICANT: FrU-VI BUSINESS4AGENCY: CEnv'i mC�1 <br /> ADDRESS; '3�, 55 . W;l5A , re ;31vd t�-15_0 CITYISTATE/ZIP: �5:r r7 � <br /> PHpNF(1): PHONE(2) _ _ " FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE.. _ i', Time: <br /> (Please allow 10 business days from date of application submittal-"Tanta6v.e:on)y-must be Confirmed} <br /> ❑ <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FEE CC <br /> ASM OprCHECK ONLY)-REQUEST PRQCES517-D IN 3 5VSINE95 DAYS <br /> SIGNATURE OF APPLICANT _ DATE 21 201 <br /> Electronic Information: [: List❑ Map—Description- <br /> FILE <br /> Description:FILE ADDRESS IE EHD USE ONLY <br /> street# street flame City0 Unit 1 <br /> T. Lo,+ JU_ rC <br /> 2 c <br /> ❑tinil2 <br /> 3: <br /> 4. h <br /> Unit3 <br /> s. t CA.Iev ,2- i2 nit a <br /> 7. t <br /> S- ❑Unit5 <br /> 10. ❑UnitB <br /> Specific Bate Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEP,IENT I+' SOLID WASTE FACILITYIVEHICLV <br /> THER CI_EANVP SITE(NON-LOP) ❑FOOD FACILrTY U.WASTE TIRE <br /> UNDERGROUND TANK(MONiTORINGIREMOVAL) ElDOU KENNEL C1 DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATtAENTPLANT <br /> TIERED PERl1ITTED FACILITY ❑MOTELIHOTEL ©PUMPER TRUCKIYARDICHEMIGALTOILETS <br /> ❑TATTOOIHOOY PIERCING ❑PCIOUSPA ❑LAND USE APPLICATION SRE5 <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEA5F.SPECIFY) Ii <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA81_E 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 apprapnata <br /> box(as). At least one file typo MUST be selected. OS 64 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. w <br /> 2. The EMD will notify the applicant If any EHD fifes 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. p <br /> i, <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. n <br /> Future file reviews by the same applicant may require a$122 deposit prior to review, <br /> EHn USE ONLY <br /> ii <br /> EHD 48-06 _ �� --- - - - 67129!10 <br />