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------------------ -� <br /> 10) <br /> En <br /> DATE RECEIVED EHC LOG NUMBER <br /> :� <br /> .�� SAN J <br /> � j gip! OAQUIN COUNTY <br /> U (� <br /> ENVIRONIENTHEARENVIRONMENTAL, HEALTH DEPARTMENT <br /> tj 800 Fast Main St, Stockton, CA 952023029 <br /> `"°PE'RM1T/SERV1C lephone. (209)4683420 Fax: (209)464-0138 Web: www-sjgov.org8d4 <br /> �.�i`�r►�-�, .ru-ros�`��.�f�PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:— �[ (�� - BUSINESSIAGENCY: <br /> ADDRESS: `N00 „ ar <br /> PHONE(7)= 0!6 978-: 1 , CITYISI'A7r1ZIP: <br /> G <br /> L 0 PHONE(z): X; K CSIMILE: � <br /> TEN'FATJVE*APPOINTME'NT DATE: Time: <br /> (Please allow 10 Buelnoas days from date of appllcatlo submittal-"]'sntatlre only-must be confirmed) <br /> ❑CHECK BOX 7O EXPEDITE REQUES $t. FEE ECK ONLY)-kr;QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATES <br /> Eloctronic Information: ❑List[j Map-Description: - <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City <br /> �. NF dl�� Unit1 <br /> 3. -- �— Unit 2 <br /> 4. <br /> 5. <br /> Unit 3 <br /> 6. <br /> 02 U <br /> 7- nit a <br /> 8. I <br /> 9 Unit 5 <br /> 10. <br /> ❑unit 6 <br /> Specific hate Range of Information Requested: From to <br /> IrNVIRONMIiNTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING Ai3ATl;MENr Ej SOLID WASTE FACILITYNEHICLE <br /> OT14CR CLEANUP SIRE(NON10P) ❑FOOD FACILITY [J WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINWREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑1 WARDOUS WASTE GENERATOR 0 CHICKEN RANCH <br /> ❑TIERED PERMIT rrm FACILITY ❑MOTELIHOTEL 0 WASTEWATER TREATMENT PLANT <br /> Q TATTOOMODY PIERCING ❑POOL/SPA [I PUMPER TRUCKJCATION SITES TOILETS <br /> Q MEDICAL WASTE FACILITY d LAND USE APPLICATION SITES <br /> OTHER(PLEASE SPECIFY <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW, MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAY$) <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. F x to(2091464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications reeelved after <br /> 3:00 pm will be processed the next business day, <br /> 2. The EHD will notify the applicant If any EHD tiles 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 he scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A now 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$115 deposit prior to review. <br /> 5. If you need Further assistance,please contact Diane Martinez,at(209)468-3425, <br /> EHo USE ONLY <br /> EHO"-05 <br /> efz7l88 <br /> TO/TO 39Vd ONI -1VH-LN3S0d d3GN3H b06b8L69T6 TT:t?L' OTH/01/90 <br />