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[ ISL '°N �[OZ '0l 'AON ;w11 PaAl ;)ad <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> / 10/' / � ENVIRONMENTAL HEALTH DEPARTMENT 7 W"I T7 <br /> �' 2 1868 East Hazelton Avenue, Stockton, CA 95205-6232 a <br /> Telephone; (209) 468-3420 Fax; (209) 464-0138 Web: www.sjgoX..or eh L 44 1 111 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: (Q.1�E✓- `lam <br /> ?�;3� 11� C�-�fL - CITY/S •M•ov�. � SC <br /> ADDRESS: TATE/ZIP: G PHONE(1): � <br /> FACSIMILE; 9/ 9 f <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOY,TO EXPEDITE REQUEST S1 FE <br /> 5C SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BU51NES5 DAYS <br /> SIGNATURE OF APPLICANT ( �' DATE <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 1. T A?,0 X17 <br /> 3. O irVQ �` 1 Unit 2 <br /> -- , - 0 <br /> 4. _ > - - unit 3 <br /> 6. C&Unit 4 <br /> 7. <br /> 8. <br /> Unit S <br /> 10. I Unit B <br /> Specific Date Rango of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) [[?HOUSING <br /> EDICAL WASTE FACILITY [SOLID WASTE FACILITYNEHICLE <br /> THER CLEANUP SITE(NON-LOP) ABATEMENT � ASTETIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 00D FACILITY [/DAIRY <br /> Ef ABOVEGROUND TANK 5 CHICKEN RANCHI DOG KENNEL [/WASTEWATER TREATMENT PLANT <br /> []HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL WUMPER TRUCK/YARDICHEMICAL TOILETS <br /> ©TIERED PERMITTED FACILITY ❑POOL/SPA LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORD$ARE AVAILABLE FOR REVIEW; MONDAY�FRIDAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. Lit up to ten addres,gg in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one fila type MUST be selected, Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance In Identifying the nature and content of EHD records,please contact EHD at the number noted above, <br /> 3. 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 /> 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$130 deposit prior to review. '**BOXED AREA-EHD USE ONLY _ <br /> I <br /> s <br /> 0 Records provided by Staff-PPR Complete. Staff Name; <br /> EHD 49-060810114 ■ <br /> Ill <br /> C+,10 'ONI 111(11JN1TIIV Ihl( JCI :C fel A7 'Ill 'AnNi _ <br />