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�f1 ' I'vli K2 <br /> DATE RECEIVED � EHD LOG NUMBER <br /> J1 I 1 1I , YnSAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 7oc Cm,, G,o( BUSINESS/AGENCY: f�n16yF-0 :3fNc <br /> ADDRESS: 880 faC Ivor• s{, 1E3 CA <br /> PHONE(1):(925) 570—y'056v _PHONE(2):(A01) 835- -66/0 FACSIMILE: ��09 935—0675 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-�93.00 F (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 10" 317106 <br /> UNIT DISTRIBUTION 11 Unit Unit 2 ❑ Unit 3 '9 Unit 4 ❑ Unit 5 ❑ Unit 6 ❑ Other(electronic/lists/maps) <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1. �u�j an and /prrl„1I� ! Rd T-ac <br /> 2. <br /> 3. <br /> 4. <br /> 5. ��� <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> Specific Date Range of Information Requested: From I!/9 9 y to 1/,A.O& <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑ PUMPER TRUCKNARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY PT OTHER(PLEASE SPECIFY) A,,, ;�o ;w� f^Ic GAS <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 <br /> appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 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 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 <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 file not returned in the same condition as released will be reorganized by EHD staff at the expense of the <br /> applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> yf <br /> :tom 4�n <br /> EHD 48-02-006 <br /> 1/14/05 <br />