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DA ">, M SIV 1 EHD LOG NUMBER <br />N� 9 SANOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT � <br />JUL 13 20 i.', 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd � ,( <br />Er'1'1-rfRONpLfa MTALPUBUIC RECORDS RELEASE f PPUCATION <br />'PLICANT: C/� %✓ .'Li ��11'�%1 BUSINESS/AGENCY: NAG <br />ADDP.ESS: T} Ir (- l'2_ 90 CEFYlSFATE/ZfP:.u.�i - Gam, —1 -ate,- <br />PHONE(I): C=1fU `t l's- (.: i f k i` "f () F �` (,:) 22—s-2, 4 <br />PHOI'.E 2. FAk OR E-ftiRA[_: L I' s u <br />Please allow 10 business days from date of application submittal for the retards to be available. ` <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOY TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />1. List up to ten addresses in the space below. Select the type(s) of files from the list below by checking the appropriate <br />box(es). At leastone file type MUST be selected. Fax to f209) 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 cond fion 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 />kh[ELL AND SEPTIC PERMIT RECGRDS ARE AVAILABLE FOR REVIEIri/: 10010AY-FRIDAY 8:00 AM-5:00PM (EXCLUDING HOLIDAYS) <br />Electronic Infcrmatio is ❑ Lest ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />r USE �v <br />EHD OL <br />FILES <br />M UNDERGROUND TANK (US <br />Street # <br />Street Name <br />City <br />1 <br />4t,t • • VC/ `J'(� [(�% <br />CONSUMER <br />CLEANUP SITE (LOP) <br />,OTHER CLEANUP SITE ( O LO <br />1WHAZARDOUS WASTE <br />; <br />E]DAIRY <br />TIERED PERMITTED FACIL �' <br />2 <br />, ^ <br />` -[r <br />A <br />^ (l <br />4! <br />j.�.� ' { / �( <br />"Il�(�`�•'t�•!1 <br />^ (��' <br />'V <br />Y`/ <br />ABOVEGROUND TANK <br />UST (MONITORING / REMOVAL) <br />HAZARDOUS MATERIALS � <br />r.I . �( n. (1� �j <br />1- , r � �,r <br />� On l� � <br />I l lily <br />n <br />V�r�- <br />❑ PWS <br />f!a• e <br />111 <br />CUi ` <br />® SPILURELEASE RESPONSE <br />© \NATER QUALIT <br />SOLID WASTE FACILITY / VEHICLE <br />4 <br />F-l FOOD FACILITY <br />' <br />S <br />SITE MITIGATION <br />lJ POOL/ SPA <br />DAIRY <br />�. LAND USE APPLICATION SITES <br />I-] HoUGIr:G <br />SEPTIC PUMPER TRUCK/ <br />YARD /CHEMICAL TOILETS <br />T <br />f� q p��� /•�� <br />I,�EI F`.• 7`El1�I l,4 AI /T <br />[�CUPA <br />.nf WASTEWATER TREATMENT PLANT <br />'❑ HOUSING ABATEMENT <br />MOTEUHOTEL..`T <br />❑ CHICKEN RANCH / DOG KENNEL <br />S� <br />lOu[l'J. <br />-0Q114/ <br />'n ❑ <br />• D V <br />" ' <br />�CUPA- I 1 <br />❑ MEDICAL WASTE FACILITY <br />t 1 ' <br />TATTOO/BODY PIERCING <br />di SOLID WASTE <br />WASTE TIRE <br />g <br />I <br />t m BJ � q�f <br />COMPLAINT <br />(O�THHER(PLEASElSP'ECIFY): <br />r e-1 <br />10 <br />n( j� <br />`V k/✓ I <br />�)�V VWI � <br />❑ ACCOUNTING <br />nUAr LJ FAKCN - Cr7U UJC UNLT <br />I ❑ Records provided by Staff -PPP. Complete. Staff Name: ( ,{mal k ) / ���r) / 11.�„. i I <br />FI-Ih AR-nF <br />