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FILE <br /> ID F,QF,IVEHD LOG NUMBER <br /> MMM+++eee D BAS JOAQUIN COUNTY <br /> OCT 2 6 2016 ENVIRONMENTAL HEALTH DEPARTMENT �?G\(,04AOWI <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> F"RoW.E.WTALNWWhone: (209)468-3420.Fax: (209)464-0138 Web: WWW.Sjgov.org/ehd89 q 12. <br /> PUBLIC RECORDS RELEASE APPLICATION # <br /> APPLICANT: WftL' Rut§ 3 <br /> U, BUSINESSIAGENCY: % 0k %ID(A krrC t 1k4I, <br /> ADDRESS: � CJ ? S Q WE 3Z CITYISTATEIZIP:1%��N�� , CA 1 150-0— <br /> PHONE <br /> 0(Q <br /> PHONE(1): AtVjAiij PHONE(2): FAX OR E-MAIL: r(& \Ca 1t)'CtJILt,�1ASCO*?S <br /> Please al ow 10 business days from date of application submittal for the records to be available. vjw\ <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑CHECK BOX TO EXPEDITE T-$13 H HECK ONLY)-REQUEST PROCESSED <br /> IN 3 BUSINESS DA S <br /> SIGNATURE OF APPLICANT DAT1 <br /> Electronic Information: ❑ List n Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# street Name City <br /> t .(llQ� <br /> YN\T�'�V F-1 Unit <br /> 4. ❑Unit <br /> Unitt 3 3 <br /> 5. <br /> 6 iUnit? <br /> 7 0 Unit 4 <br /> $ , t SITE MITIGATION <br /> 9. <br /> M"Unit 5 <br /> i <br /> 10. <br /> Specific Date Range of Information Requested: From to <br /> EtMROtsMENTAL HEALTH DEPARTMENT FILES SOLID WASTE FACiLITYIVEHICLE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) F-1MOTEL/HOTEL <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT KiFow FACILITY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑WASTE TIRE [I DAIRY,POOUSPA <br /> ABOVEGROUND TANK ❑CHICKEN RANCH/DOG KENNEL E]WASTEWATER TREATMENT PLANT <br /> HAZARDOUS WASTE ❑MEDICAL WASTE FACILITY ❑PUMPER TRUCKNARD/CHEMICAL TOILETS <br /> HAZARDOUS MATERIALS ❑TATTOOIBODY PIERCING ❑LAND USE APPLICATION SITES <br /> IERED PERMITTED FACILITY ❑COMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND 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$130 deposit prior to review. <br /> —*BOXED AREA-EHD USE ONLY" <br /> 0 Records provided by Staff-PPR Complete.staff Name: <br />