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7 <br /> T <br /> iwHlJ L05 NUMBER JOAQUIN COUNTY <br /> DSC X010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 Fast Main St. Stockton, CA 95202-3029 <br /> hone: (209)468-.3420 Fax: (209}464-0138 Web: www,sjgov.org/ d <br /> Nva o is R�� PUBLIC RECORDS RELEASE APPLICATION <br /> R+m�n �uarcracmmimsia <br /> ..-..-_APPLICANTt.-- - - _f- - - --- --- - ._....-- - -- ----EUSINESSIAGL:NCY:T:T Mk - ---------^ - - <br /> ADDRESS: 3017 1G6'.'C SI "I' td0 CITYISTATE/ZII?: ^r4n uicfu�� cA qj-m <br /> PHONE(1). 916- ?8g-D'j*9 PHONE(2): 911- 12q-2096 FACSIMILE: 416. 9'0-6gJa <br /> rEIVTATiVEIAPPOINTMENT DATE: /Om-00 672-.'tj4u r 4Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative v ly-must be confirmed) <br /> ❑CH1=CK BOX TO ExPE v TE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS � <br /> SIGNATURE OF APPLICANT DATE Izfa2/JO <br /> Electronic Information: Lis ap—Description: FIJI oiv...t4 1 re1.1� 4d +i. Vie/a 4 <br /> FILL.ADDRESS EMD USE ONLY <br /> Stro.ot f$ Street Namo City El Unit 1 <br /> 1• fY6.r 4;neol <br /> 2• nunit2 <br /> 3. (!� <br /> 4. <br /> nit 3 <br /> 00, <br /> 5• <br /> 6. 0 t`.a' <br /> W El Unit 6 <br /> 'd- <br /> Unit s <br /> 4 <br /> specific Data Range of Information Requested: From J/1,190 _ <br /> to 12J2ao3 --_-- -- _ _-- <br /> ENVIRONMENTAL HEALTH DEPARTMENT PILES <br /> [[UNDERGROUND TANK(UST)CLEANUP Sfm(LOP) [DHOusiNs ABATEMENT El Soul)WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(HON-LOP) ❑Foon FACILITY ❑WASTE TIRE <br /> [HNDERGROUND TANK(MONITOkING1115MOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR ©CHICKEN RANCH ❑WASTl;wr"TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ©MOTEI.IHOTeL L]PUMPER TRilCKIYARDICMEMICAL TOILETS <br /> ❑TATiOOIBODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTMOR(PLIr E SIIECIFY) <br /> WELL AND SEPTIC PERMET RECORDS ARE AVAILABLE FOR REyiEw: MONDAY-FRIDAY 8:00 Am-5t00pm(ExpLuoING HDLmA1ts) <br /> 1. List up to tan addre§gg2 In the space above. Select the type(s)of files from the list above by checking,the approp0ate <br /> box(es). At lQuat one file type MUST be selected. F x to 46 1 r mail to tho ddresa 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 I^HA will notify the applicant if any EHO 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 some applicant may require a$125 deposit prior to review. <br /> END USF ONLY <br /> AHI?�6-06 0712WID <br /> TO/TO 30ed 031NV S 06VOT989T6 ZT:91 OTOZ/ZO/zl <br />