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R <br />/ "^ ca <br />llo, 3119 EHPJMBER <br />-, ' SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />168 East Hazelton Avenue,, CA 95205-6232 <br />( 2016 Telephone8(209) 468-3420 Fax: (209) 4164-0138 Web: www.sigov.org/ehd <br />r3�Fs=•TP.Liii PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY:'&/'I0"v1 N cry PUB.W2� <br />ADDRESS: /810 �•. by , CITY/STATE/ZIP:', C.+ Sao 5 <br />PHONE (1): ZQc - t (Q&-, TLfjLf PHONE (2): FAX OR E-MAIL: 209 - q&g -.2�1' j <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 ST - $1. - (C H ECK 0NL`- REgUEST PRQCESSEp IN 3. B SINESS_DAYS <br />SIGNATURE OF APPLICANT DATE <br />1. List up to ten address space o S ct t e De(s) of files from the list below by checkln th appropriate <br />box(es). At least one file type MUS selected. F t 209 464-0138 or mail to the address indicated above. Address <br />ranges will not be accepted. Applications received a r3:00 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 $139 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Informatlon Requested: From to <br />""BOXED ARE/• END U3E ONLY"' <br />R rrui�fu���"IQ�9�i7t,.�Il�� <br />EHD 48.06 <br />iE <br />j0 <br />-....ENVIRONMENTAL.... <br />FILE ADDRESS <br />EHD USE ONLY <br />UNOERGROUNO TANK (VST) <br />Street # <br />Street Name <br />City <br />I <br />W , ma S <br />�- j� <br />`� <br />n 'n 1" 1 CONSUMER <br />� 10 y i F- + Itw,m c N <br />1 1 r _ J r v l / / I <br />CLEANUP SITE (LOP) <br />-4OTNER CLEANUP SITE (NON -LOP) <br />HAZARDOUS WASTE <br />TIERED PERMITTED FACILITY <br />i�"'AeOVE0ROVND TANK <br />�v <br />MST (MONITORING / REMOvAL) <br />F j y., � <br />Cil I <br />Lj PWS <br />,HAZARDOUS MATERIALS <br />/ <br />l <br />I a <br />'�^j/�f <br />W• // l a h �w S <br />. <br />�SPILLIfiELEA9E REBPQNBE <br />II <br />�-y' <br />�D> <br />l/4� ��- <br />/ <br />Gi�it�h <br />W-YAR QUALITY <br />��� i •' // <br />�KWgBTE FACILITY/ VEHICLE <br />FOOD FAGILITY <br />POOL / SPA <br />( I� <br />l IG �/ <br />�i^- <br />SITE MITIGATION <br />DANAIRY <br />(� <br />r/ <br />LD USE AppLK:ATIQN $rrE8 <br />S � � <br />Q <br />S �� � D � O J� • <br />/i <br />�•a/�- <br />d <br />w ►'Y1a�'hews <br />1 <br />9 HOUSING <br />rte= <br />SEPTIC PUMPER TRUCK / <br />YARD /CHEMICAL TOILETS <br />9WASTEWATER TREATm2NT PLANT <br />. <br />QHOUSINGABAT2mENT <br />MorEL/HoTEL <br />MoTEU <br />F^ ^ � <br />_ <br />� <br />CUPA <br />CHICKEN RANCH / aOG KENNEL <br />CUPA - U5Y <br />MEDICAL WASTE FACILITY <br />TATTOO/BODS' PIERCING <br />9 <br />$00- WASTa' <br />WASTE TIRE <br />COMPLAINT <br />F-] 011iER(PLE'AsE SPECIFY): <br />ACCOUN7INC <br />10 <br />""BOXED ARE/• END U3E ONLY"' <br />R rrui�fu���"IQ�9�i7t,.�Il�� <br />EHD 48.06 <br />iE <br />j0 <br />