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08/01-L_2�Q,14 3 : 12 : 15 PM -0400 FAXCOM ANYWHERE PAGE-2 OF 2 <br /> DA ACEI N ED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> AUG 0-1 2014 ENVIRONMENTAL HEALTH DEPARTMENT <br /> EIVVIRONiL1EIVF,gLH � phon <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 9 <br /> e: 209 468-3420 Fax: 209 464-0138 Web: www.s ov.or /ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: cr-/ f„r i>1i BUSINESSIAGENCY: <br /> ADDRESS: �I, Sit- CITY/STATE/ZIP: ✓\o5zv:l�t CGI <br /> PHONE(1): PHONE(2):..6//, 311 -535,4/ FACSIMILE:, '2"� 92F,/- <br /> Please <br /> 7 � <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-$12 EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �' W DATE ( JLf <br /> Electronic Information: ❑ Llst O Map-Description: <br /> FILE ADDRESS EHD US ONLY <br /> Street# Street Name City nit 1 <br /> . , <br /> 1 <br /> 2. <br /> _F1 Unit 2 <br /> IN A <br /> 0,1 <br /> 4. /I <br /> ...... Unit 3 <br /> 5. <br /> 6. <br /> ............ <br /> E]Unit 4 <br /> 7. <br /> 8. .E41H.... ............ <br /> _. _..............---.. <br /> _ ............. _. _ D units. <br /> 10. / <br /> C�fnit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ®MEDICAL WASTE FACILITYSOLID WASTE FACILITYNEHICL //,,� 1 <br /> OTHER CLEANUP SITE(NON-LOP) El HOUSING ABATEMENT ❑�WASTE TIRE 5 F7 IPSr wl[I <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> [ABOVEGROUND TANK v", ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE/HAZARDOUS MATERIALS ❑MOTEL/HOTEL <br /> ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> TIERED PERMITTED FACILITY O`- ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING D4 COMPLAINT/RESPONSE 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.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$125 deposit prior to review. `*"BOXED AREA-EHD USE ONLY` <br /> I rq M 4 ! r((AS) KIXS <br /> 7N LE, <br /> E' D _ M 7 <br /> I�in Records prouided-bySi:aff-F?F?RGomplete.-s+a�. <br /> 0 <br /> EHD 48-06 <br /> F]e oo (7 r �^ �. o` i Ila �� �<► ;PT 510 u C8114 <br /> Received lime Hug. 1. 2 14 T � �0.�6 ,��� �'F" ����°''n ''^ �'0'ti' U�'s17 <br />