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RCVCIVCLJ . • <br /> JUN 0 7 2011 Submhbymau PrihtForm <br /> 0 <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> COntacffNVIRONMENTAL HEALTHENVIRONMENTAL HEALTH DEPARTMENT ��� <br /> Yvette PERMIT/SERVICES <br /> direct phone 600 East Main St. Stockton, CA 95202-3029 <br /> 209-458-3421 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> or Cheryl Field PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: a rZZ d( $ U 4 BUSINESSIAGENCY: p E T r� tt I �� <br /> ADDRESS: 2S-©C7 CITY/STATE/TIP: <br /> PHONE (1): (Cf2.f)� {Sa�(ao t PHONE(2):gd "60C�b FACSIMILE:SR21'� 4uC,' toD99 <br /> TENTATIVE*APPOINTMENT D TE: Time; <br /> IPleaeo allow 10 buslness d from date of application submittal-"Tentative only-mast be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REALCASH OR CHECK ONLY) REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 6La-/Lo 1 t <br /> Electronic Information: R Lls Map—Description: ccs S� t to tS` pw <br /> FILE ADDRESS EHD USE ONLY <br /> Street rl Street Name City Unit <br /> 1. Cp ppl.c�(e5' AvP_ <br /> 2_ �} y � e e-e.pt- �r}(yam /taw Unll2 Y <br /> 3. If ' <br /> 4. (�{ �P/S Q� ... 6nit3 <br /> S. <br /> 6. XrUnit 4 <br /> 7. <br /> $, ❑Unit 5 <br /> 110. Unit 6 <br /> Specific Date Range a/Infomlatfon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ASOLIO WASTE FACILITYNEHICLE <br /> IN OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ��{+WASTE TIRE <br /> UNDEROROUNDTANK(MONITORINGIREMOYAL) [I DOG KENNEL YjJ. DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL PUMPER TRUCKNARDICHEMICAL TOILET5 <br /> ❑TATTOOMODY PIERCING E]POOUSPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑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(2061464-0138 or mall 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 /> 9:00 pm will be processed the next business day. <br /> 2. The EMD will notify the applicant N any EMD 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 reviow, 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 avallable. <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 /> EHD U6e ONLY <br /> E <br /> B(297oa <br /> EHD 46•ce <br /> 10/10 39Vd S1NVi7nSN00 I3C 660990LSZG 89:01 ITOZ/LO/90 <br />