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---- <br /> r � A UIN COUNTY O MBE <br /> DATE <br /> SAN Jo Q C (DF <br /> 241 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUL 5 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ne: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> OwEN�q tG <br /> Nv ERM`1{S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: © �S�✓�� p BUSINESS/AGENCY: f&rt" '.!' �n �✓�PC ,� <br /> ADDRESS: S I `( f;Ft-f J-Q 10 CITY/STATEOP: <br /> PHONE (1): cl RHONE (2): FACSIMILE: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQUEST-$125 F ASH O CK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic information: ❑ List❑ Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street# Street Name City ❑Unit 1 <br /> 2. `c't q 0 f i GG o I l � VPZ <br /> .....� 3. W�j ' f ( - I I Y i , t^ IriSta ifemp4. �� . <br /> 0r1 Cn dunit <br /> 6. `���1�� ilii <br /> ®Unit 4 <br /> 7. <br /> 8• �� ❑Unit 5 <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ii <br /> U ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITY/VEHICLE <br /> EHICLE � U' e <br /> ROUNNDERGROUND <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE I t�t TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ❑DAIRY U t'i <br /> TANK CHICKEN RANCH/DDG KENNEL ❑WASTEWATER TREATMENT PLANT I '1�„�1 /.i <br /> gA�GROUND <br /> DOUS WASTE/HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <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-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(209)464-0138 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$125 deposit prior to review. ***BOXED AREA-EHD USE ONLY*** <br /> ony� i&ui ) <br /> Ck ®� cc1 s b 7JIK o r <br /> ;*t,, <br /> I,af-a b i led jeeJ. PmAdcr~1 C,p,,Qjet inC9f0)h�X-,k5fCr 19kta feu c4 i 10-940/A <br /> X 5i riasi�r �xkti�S" 5.►ci(a�b5 X41Lk+x`i X51 o j yfl, XSJ di xs,l 0)783, xs.1 d zc'ig,X ,J 0& <br /> __ <br /> JcSJ G%�- L,xSJ CZI',t , XSJ Cz%Nl, XS+Y t1z®5'!, ,C SJazz�/7� k c'1� 3„ lc+z�j3, 9r5,s 6z,.3'7, xsu d27yJ�IX4 t5 a� <br /> -X54 03417, xSJ 0352­!, x5ijr 3i`J3 �rG�'tei�$ri C b a4 ,GJf1� s�Kcc}i rasT ,n5►a.Gi d rangy-s1 <br />