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DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION 0 <br /> APPLICANT: ,s6, I?in+' BUSINESS/AGENCY: PFA <br /> ADDRESS: 3�(� , gIVA ctf- -Ac. CITYISTATEIZIP: TleccHt1�4 cA-05-4t61 <br /> PHONE(1): (olte) cq,A,5-_ 1-1.74 PHONE(2): (x5,2� sz%-3,jgo FACSIMILE: dA <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 BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS 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. to\v ustri�V �►r or. f L 1�} � <br /> 2. l ort r-I k EJ"Unit 2 <br /> 3. "tSv G <br /> 4• 'Ibo ``1 � Q6`Unit3 <br /> 5• �os1 r <br /> 6. t c/ /r p'Unit 4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. p u t 6 <br /> Specific Date Range of Information Requested: From I qac to P'tkA <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �1NDERGROUND TANK(UST'CLEANUP SITE(LOP) 2 MEDICAL WASTE FACILITY 21SOLID WASTE FACILITYIVEHICLE <br /> 9NDERGROUND <br /> HER CLEANUP SfrE(NON-LOP) F1 HOUSING ABATEMENT 2*ASTE TIRE <br /> TANK(MONITORING/REMOVAL) ❑Fg.OD FACILITY 01JAIRY <br /> ABOVEGROUND TANK HICKEN RANCHI DOG KENNEL ['WASTEWATER TREATMENT PLANT <br /> �AZARDOUSWASTEIHAZARDOUSMATERIALS ❑MOTELIHOTELDPUMPERTRUCKIYARD/CHEMICALTOILETS <br /> DIIERED PERMITTED FACILITY BOOLISPA [�JCAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING [a'COMPL.AINTIRESPONSE RECORDS []-OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:OOPM(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.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 /> ❑ Records provided by Staff-PPR Complete.Staff Name: <br /> 06!01114 <br /> EHD 4"6 <br />