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DATE RECEIVED EMD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov. d <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l C irI (ZD 6 BUSINESS/AGENN�CY: iN ' 6 <br /> ADDRESS: 31D NO(4( wltlul. City/State/Zip 5'63—3,5 <br /> . <br /> PHONE(1): �V01 g�E ��pOfll PHONE(2): ZO'f 321 Z(76 <br /> FACSIMILE: yge <br /> TENTATIVE*APPOINTMENT DATE: (2^ '-0 P Tlme: F-3� <br /> (Please allow 10 business days from date o application submittal-*Tentative only.must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUE 05 F A R CHECK ONLY)-REQUEST PROCE$SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE x'09 <br /> Electronic Information: ❑ List❑Map -Description: <br /> FILE ADbRESS EHD USE ONLY <br /> Street 0 Street Name City <br /> 1. 3 0 L' C. Or —N- �( /L ❑ Unit 1 / <br /> 2. as 73 /N lion S Sod ❑ Unit2 <br /> 3 w /S� s. ..? . 02 atn to Cf <br /> 4. cZ� D �'l �`S"op Unit 3 <br /> 5. <br /> 6. -- Unit4 <br /> 8. <br /> $ ❑ Unit 5 <br /> 9. <br /> 1 O ❑ Unit 6 <br /> Specific Date Range of Information Requested.From � to enat' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,Rl-,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑Housmr,ABATEMENT t7 SOLID WASTE FACILITYIVEHICLE <br /> PrOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WA$TS TIRE <br /> Of UNDERGROUND TANK(MONITORING/REMOVAL) ©Doo KENNEL 0 DAIRY. <br /> GeiAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> El TIERED PERMITTED FACILITY ❑MOTELIHOTEL C PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑MEDICAL WASTE FACILITY 0 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 behold 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 8/04108 PUBLIC RECORDS RELEASE APP FORM <br /> Z0 08dd NOcIINO�19N3 96LT66960Z Tb:TT 8002/LT/ZT <br />