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MC�EIyy�r��E D • SAN JOAQUIN COUNTY • EHD LOG NUMB <br /> EV <br /> Nov 14 2014 ENVIRONMENTAL HEALTH DEPARTMENT �j1 1 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ^ �� <br /> ALWI pOkbne: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd— <br /> ENVPERM10S RV!CEG <br /> UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY:_ 5-1V'-- �©� � /-4 <br /> ADDRESS:. I1 60 -W- �����,.. i4z M V'e— CITY/STATE/ZIP:_ M^ � Cff- RS33 7 <br /> PHONE(1): Vc) 734( ` If( PHONE(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 REQ T-$!MEE(CAS ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS AYS <br /> SIGNATURE OFAPPLICAN _ D / / <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Nam city Unftt <br /> 1. t7 0 5(/NL lv1/AW GL I LO <br /> 2. F}Iey <br /> ❑Unit 2 <br /> 3. <br /> 4. ti11w'� Unit3 pl <br /> 5. Aft At ''LI <br /> 6. N /f / <br /> nit4 <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILITYIVEHICLE <br /> 'OTHER CLEANUP SITE(NON-LOP) ❑.�.i HOUSING ABATEMENT E]WASTE TIRE <br /> *UNDERGROUND TANK(MONITORING/REMOVAL) tgFOODFACILITY El DAIRY <br /> ABOVEGROUND TANK ❑CHICKEN RANCH[DOG KENNEL -1 WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE[HAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD[CHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOO/BODY PIERCING - XCOMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5: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)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 /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-06 <br /> 4128/14 <br />