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06/15/2007 09:13 4157774574 AGS INC PAGE 01/01 <br /> ER l, <br /> DATE RhC�N�D� `—' <br /> SAN JOAQUIN COUNTY EWD LOG NUMBER <br /> 5 2001 ENVIRONMENTAL HEALTH DuPARTHENT <br /> ENV1!R0Nh,9E fl fiEALI_H 600 E. Main Street, Stockton, CA 95202-3029 <br /> pFrry,�� ��rFjt/l J�� Telephone: (209)468-3420 Fax: (209)464-0138 Web: www, ov.or /e)td <br /> PUBLIC RECORDS RELEASE ,APPLIC.ATION <br /> APPLICANT: y012- <br /> rr BUSINESSIAGENCY: A c, ,S _ _ G. <br /> ADDRESS: o J4' Soo O <br /> PWONE(7): s PHONE(z): FACSIMILE: <br /> TENTATIVE*APPOINTM N DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tor►tativo only-mu d) <br /> Y <br /> CHECK BOX TO EXPEDITI;REQU •595.00 E(CASH OR CHECK ONLY)•REQUEST INESS DAYS <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑List Eymap--Description: (j <br /> FILE ADDRESS �- EHi)USE ONLY �� <br /> Street# Street Name City El Unit 1 <br /> 2. 5 ( �`U 5 E '�?�- _ 1 C� Unit 2 <br /> 3. C <br /> -4• �� �YV.� �Q�Nar 11 J� >��LY1 ' .I; , !• Unit 3 <br /> 5. y Q <br /> Unit 4 <br /> 7 <br /> ❑ units <br /> zSs C, w I1Litn r �� ❑ Unit 6 <br /> 10. <br /> Specific Date Range of Information Requested: From t SO to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 171 HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVFHICLE <br /> lits OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY a WASTE TIRE <br /> EK UNDERGROUND TANK(MONITORINGIREMOVAL) CI DOG KENNEL ❑DAIRY <br /> 0t HAZARDOUS WASTE GENERATOR d CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARD/CHEM TOILETS <br /> n TATTOWBODY PIERCING ©POOLISPA 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 flies exist. An appointment for review will be confirmed approximately ten(10) <br /> days aftor receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 1 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 sante Applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> O gR•OR!;1/1:if,7q(Ify woo <br />