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05/01/2012 11: 32 41598:x,, 1 NINYO MOORE PAGE 01 <br /> [SATE RECEIVED EHD 1,00 NUMBER <br /> n SAN .IOAQUIN COUNTY <br /> F(�`;,F ENVIRONMENTAL HEALTH DEPARTMENT ryry <br /> 603 East Main St. Stockton, CA 95202-3029 <br /> i7Telephone: (209)488-3420 Fax: (209) 454-01138 Web:vvmj.sjgcv,org/ehd <br /> ep !'R0NMFt4T1,L Tt� <br /> .,,-ICFFiy►OES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: IB ?''Cer- ��s )9 BUSINESS/AGENCY: Afi �c ror� G�w�rvc�aLa an�ci.� <br /> ADDRESS: m ( liCl e(�5 � GS CITYISTA Y lelZIP: t �'rn, i� <br /> PHONE(11:5(0 G 3� —9 6 r' PHONE (2): FACSIMILE: -.9tQ 6 S 6 <br /> TENTATIVE*APPOINTMENT DATE.: 01-Lp Time: l.'3 a f" <br /> (Pleaso allow lO business(iByr fronsdate of dppl�ut?mlttal-°Tentative only•must be confirmed) <br /> [1 CHECK E30X TO EXPEDITE REQUEST-$125 FER(CASH OR CHr-OK ONLY)-REOU€ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ®List C3 Map—Description: <br /> FILE ADDRESS EWD USE ONLY <br /> street# Street Name City ❑Unit 1 <br /> r3. <br /> kt �Un_It2 64` PSL r F< c A/V�%� <br /> 4-1-76-76 h l—A 40 0 Unit nit <br /> t`L 13 ❑ 'nit 4- , 0" <br /> 'Please <br /> X <br /> Please respond as soon as possible. , 113112 <br /> I need to notify applicant during week of 5/14/12 if Unit 6 <br /> EHD has files for listed addresses or not. <br /> E(Unit 6 <br /> Spoclfic Date Range of information Requested: From <br /> ENVIRONMENTAL 1­19ALTH DEPARTMENT PILES <br /> ®UNDERGROumo TANK(UST)CLEANUP SITE(LOP) []HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ®FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(MONITORINCIREMOVAL) ©DOG KENNEL DAIRY <br /> ®HAZARDOUS WASTE GENERATOR [j CHICKEN RANCH WASTEWATER TREATMENT PLANT y <br /> TIERED PmmiTTED FACILITY E]MOTELIHOTEL ❑DUMPER a RUCKtYARDIGHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ©POOL/SPA [l LAND USE APPLICATION SITES <br /> FKJ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS E]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REv0Ew: MONIDAY-FRIDAY 8:00 Ain-5:00m(EXCLUDING HOLIDAYS) <br /> 1. List ug to ten add es 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. Pax to(209)464-0135 yr mail to the address Ind!_ a d _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 he 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 END staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> [IID <br /> �f <br /> EHD 4"5 131114'1 <br /> i J <br /> f <br />