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F <br /> DATE RECEIVED EHD LOG!NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax. (209)464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS`RELEASE APPLICATION <br /> APPLICANT: Wendell Youngsma BUSINESSIAGENCY:SJ County-Economic Dev Dept <br /> ADDRESS: 56 S.Lincoln Street CITYISTATEIZIP: Stockton CA 95203 <br /> PHONE(1): 209-46"619 PHONE(2): 209,468-3615 FACSIMILE: 209-468-3666 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days From date of application submittal-*Tentafive only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$125 FEE(CASH OR CHI=CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE <br /> i <br /> Electronic Information: ❑ List❑ Map--Description: <br /> FILL;ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 1. 19501 N HWY 99 Acampo <br /> 2. . <br /> ❑Unit 2 <br /> .3. <br /> 4. <br /> ❑Unit 3 <br /> 5. <br /> 6. <br /> 2l EEl-unit4 <br /> 7. <br /> 8. <br /> do- ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific slate Range of information Requested: From to � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILrfYNEHICLE <br /> ❑OTHER CLEANUP SITE(NDN-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY ; <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIE30DY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REyiEw: MONDAY-FRIDAY 8:00 Alta-5:00FM(EXCLUDING HOLIDAYS) i <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 feast one file type MUST be selected. Fax-to{209)464-0138 or mail to the address Indicated above. Address a <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after l <br /> 3:00 pm will be processed the next business day." <br /> Z 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"roview. 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 filo 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 /> FHD USE ONLY <br /> EHD 4846 41231.E2 <br />