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fA�.�k EI 'v f4s V • EHD LOG NUMB <br /> !"�L SAN .10AQUIN COUNTY 1 <br /> NOV 14 2014 ENVIRONMENTAL HEALTH DEPARTMENT � <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ,R`�� JJ <br /> VPEpM ( ftUtl �tbne: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: rfkPi <br /> { BUSINESS/AGENCY: 5"/' <br /> ADDRESS: I�� t �. �nCevtittC ,tv� CITY/STATE/ZIP: M*w4c-' � C� c'33) 7 <br /> PHONE(I 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 EE(CAB ECK ONLY)-REQUEST PROCESSED IN 3 BUSIN .$DAYS <br /> SIGNATURE OF APPLICA DAT — <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Namy City ,ZrUnit1 <br /> 1. Zi7 L 05�/WL 1v1/,LW OL I LQ <br /> 2- 2 FtIEO/ El Unit <br /> 3. 07w% f <br /> 4. 1'rlb#� �� Unit3 �•1 `ry�} <br /> 5. Aft /} t <br /> 6. I! IY l <br /> nit4 , <br /> 7. <br /> 8. <br /> ❑Unit 5 <br /> 9. <br /> 10. <br /> ❑Unit fi <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY F-1SOLIDWASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) gFOOD FACILITY ❑DAIRY <br /> Lj ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTELIHOTEL ❑PUMPER TRUCK/YARDICHEMICAL TOILETS I <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING WOMPLAINTIRESPONSE 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 /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> EHD48A6 <br /> 4/28/74 <br />