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09/18/2007 TLTE 10:57 FAX a001/001 <br /> M�'� j� , EHD LOG NUMBER <br /> SAN JOAQiTIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> � ' $ 2007 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.or1 / 007"07 <br /> E�►V1R4fvf�3ENT HcALTH PUBLIC RECORDS RELEASE APPLICATIO <br /> APPLICANT: r-�_e. b(i 0— HUSINESSIAGENCY: LA1�S C `�r P U✓`���� <br /> ADDRESS: 2-11i>_1 U (—G_t--&Way OCiDV-1 v-17 ( L,L.I -('C' Sc"-- e• -ty ci" C-{'.ss-3 <br /> ,1 ^CA V1-,f�vl !.. <br /> PHONE(1). 9 Ila• (yy fl— 7'3 LA LP 9Ili 015 - - 1 I �'C �- <br /> PHONE(2): .7FACSIMILE: q I I <br /> TENTATIVE*APPOINTMENT DATE: �� L' i Z t Tlmo: 10 cc <br /> (Please allow 10 business days from date of application submittal-'Tontativa only-must be conrirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-S98.90EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS EHU USE ONLY <br /> Str00t# Street Name _ _City <br /> 1�61S�,I /j1 �fi. ❑ Unit1 <br /> 2. ❑ Unitz <br /> 3. <br /> 4, ----- /!Unit 3 <br /> --- <br /> -5 _ <br /> 6. unit4 \� <br /> 7. <br /> 8. - ❑ Units <br /> 9. <br /> 10. i <br /> —_ ❑ unit 6 <br /> Specific Date Range of information Requested:From Al A ed--a to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �l1NDEROROuND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT O SOLID WASTE FACILITYMNICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑WASTE TIRE <br /> TrUNDEROROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL M DAIRY <br /> HAZARDOUS WASTE GENERATOR L7 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> I'TIERED PERMITTED FACILITY O MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑TATTOO/BODY PIERCING 13 P0041SPA O LAND USE APPLICATION SITE$ <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. SLalact the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected, ag to 208 464-0138 or mail to the address indicated 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 be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> e that IS actively being worked on by EFID 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$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> SHO 16-0C WEB 11/02007 <br />