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DATE RECEIVED 10 46 EHD LOG NUMBER <br /> SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> QJ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> (�\ PUBLIC RECORDS RELEASE APPLICATION <br /> J J ' ' -e <br /> APPLICANT: I/ttwtln - pmt U / k BUSINESSIAGENCY: ecr, ut_-riAJ6- )S7_— <br /> ADDRESS: f 1 i v t CITY1S/TAT`rEIZIP:�& �� 175; f8 <br /> PHONE(1): �6C— � !` �/ PHONE(2): ^ (,f j—(O&7 FACSIMILE: Q —3C Sig <br /> Please allow 10 business days from date of application submittal for the records to be availahle. <br /> Staff will contact you to.arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE REQUEST $125 FE (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUS/ ESS DPIS <br /> SIGNATURE OF APPLICANT �� DATE AW �,7q Z01 <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> ACT <br /> 2. <br /> 2. .. �''VP�N (� /�"� /.C�J� 1�y�1�,`.� ❑Unit2 I <br /> 3. �V ' <br /> 4. 1� V� Unit 3 <br /> 5. <br /> 5, !�/ /� nA4 <br /> 7. or I <br /> 8, ❑Unit 5 <br /> 9. <br /> 10. ❑units <br /> Specific Date Range of Information Requested: From PFS to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTETIRE <br /> jj§UNDERGROUND TANK(MONITORINGIREMOVAL) ❑FOOD FACILITY ❑DAIRY <br /> ❑ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> ❑HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICALTOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-S:OOPM(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)484-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. 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 /> 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. *`*BOXED AREA-EHD USE ONLY*** <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> 4128114 <br /> EHD 48-06 <br />