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DATE RECEIVED <br /> ECE' � <br /> .� �' SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ; <br /> ') 600 East Main St. Stockton, CA 95202-3029 <br /> "telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �1/1;��aoorp BUSINESS/AGENCY: <br /> ADDRESS: SIOI Vale Maly CITY/STATE/ZIP:_f:IK <br /> G1rovp C p- 9'STSB <br /> PHONE (1): (ot*t -ji4 b - S7o I PHONE (2): FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-'Tentative onlyTime: <br /> -must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT rDATE <br /> Sf ;vlo2 <br /> Electronic Information: ❑ List ❑ Map- Description: <br /> _T_ILFILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> 1 3 00 SO�•t-In ❑ it 1 <br /> B�ckma� Lo� OZ �! <br /> 2. <br /> 3 Unit 2 <br /> 4. <br /> 5. ❑ Unit 34 v <br /> 6. <br /> 7 dUnit 4 <br /> 8. <br /> 9 ElUnit 5 <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From Jar. ZOn A to J Ur ,x.01,2 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ®UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT []SOLID WASTE FACILITYNE LE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE } <br /> UNDERGROUND TANK(MONITORINGIREMOVAL);� T❑DOG KENNEL ❑DAIRY _ <br /> ®HAZARDOUS WASTE GENERATOR� F] ®WASTEWATER TR T ENLA T CHICKEN RANCH � �T <br /> ®TIERED PERMITTED FACILITY ❑MOTEL/HOTEL <br /> ❑ <br /> TATTOO/BODY PIERCING ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑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)464-0138 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. <br /> 2. 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 /> 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. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EHD USE ONLY <br /> i <br /> u <br /> J <br /> EHD 48-06 <br />