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DATE RECEIVED EHD LOG NUMBER <br /> IR <br /> SAN JOAQUIN COUNTY ��,// <br /> E C;L I�'�Ui(4 i ' EOT60NMENTAL HEALTH DEPARTM) NT <br /> 600 East Main Street, Stockton, C8 Web: <br /> w 708 <br /> w.sj �j � <br /> JUN 2 5 2008 Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov. r Jf� <br /> ENVIR0Nh1Er4( riLpjh PUBLIC RECORDS RELEASE APPLICATION <br /> • V�1 Q(� <br /> APPLICANT: ���NG.e.- /Je/-'Yl'! 4N BUSINESSIAGENCY: <br /> ADDRESS: - -0,7 SaWM IL-1 L/N Go 14 y$ <br /> PHONE(1):,(9�LJs'Sl3—(, Z I C1 PHONE(2): +L106-9S-- `V'V 4// FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dale of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT2 ,. -tea DATE 6 zS o <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY _ <br /> Street If Street Name City ❑ Unit 1 <br /> 1- a6 7-63 A)- 77&f o 0 0 <br /> 2 ❑ Unit 2 <br /> 3. <br /> 4. ❑ Unit 3 n\\ <br /> 5. ❑ Unit4 <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> n <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 9 TAHOUSING ABATEMENT ❑SOLID WASTE FACILITYfVEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑TATTOOIBODY PIERCING ❑PGOUSPA ❑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(209)464-0138 or mail 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 /> 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 /> 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 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 /> If you should need further assistance please contact Diane Martinez @ (209)468-3425 directly. Thank You***_ <br /> EHD4346 9!1412006 <br />