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LL60 '°N 01" ' l 91H 'Sl '��r ;lull panIaOa� <br />Pr�E_m-Q <br />OATP I E D !� 5 EHD LOC NUMBER <br />Gs <br />p SAN JOAQUIN OUN cY <br />5 2016 ENVIROi�MEN T AL i-EkLTH DEPART MEl~I T � z � `; � �. <br />Y <br />1866 East Hazelton Avenue Stockton CA 95205-6232 "' <br />t IPS L HE I , T elephans: (209) 468-3420 Fax: (209) 464-0138 Wab: www_sjgov.o -&hd ti n - <br />OREpU <l!,`SERV10ES PUBLIC RECU'RDS kELEASE APPLICATION <br />APPLICANT: V <br />AIJ:DRE3S:. _ LM40 Hill Sj Sui��1� <br />S Y/STATE1ZIP:__ I?�� 6��J a4�0� <br />P�C)Nrz (1): -1-15- PHONE (2): FAX OR g M_AIL, :t4c� acmcoeCynsulizInij. CI <br />Please alloys 10 business days fr®m data of applicattion aubnllf,al for the recd -ds to be available. <br />Staff V ill contact you to arrange an appointment date and time to review the •equested records. <br />❑ CHECK BOX _0 EXPEDITE REQUEST - $130 FE (CASH OR CHECK ONLY) - REQUEST PRO ''ESSED IN 3 6USINESS DAYS <br />SI NAT URE OF APPLi 'ANT � _- OATS `i� IS l <br />9. I-Ist up to ben Lddr -sses In the spaL. below. Select th9 type(sl of files from the list belcca by checking tate appropriate <br />box(es). At least c is fila type MUST be selected. Fs=;(m)Ai 038 or ii2ali t4 the -iib rsas Indicated above. Address <br />I ranges gill n©t be iccepted. Applications received after 3.00 peva will be processed the iia d business day. <br />2.1 For assistance In I !eerifying the nature and content of E14D teacoedg, please contact Etil) it the number noted above. <br />3.1 The EHD will notit• the applicant If any F_HD files Exist. An appointment for review vdil Ise confirmed approx-I Gately ten (10) <br />1 days after receipt If application. The files will be hold for a maximum of fire business E la �s for review. Appolntments <br />should be schedul W accordingly. <br />d 'Any fiie riot return -d In tho same condition as released will be reorganized by EHD staff' e t the expense of the applicant. <br />Future sal a....I g; by the same applicant may rogUire a $139 deposit prior to revlovw. <br />e i.i oases ee c rv� C �P a <br />WI LL ANO SEPTIC F EPMIT RECOP13S ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 All 1-5:00FM (EXCLUDING HOLWAYS) <br />Elecir®nlv infyrrnat on: ❑ List ❑ Map — i)ascrlptlon: <br />Specific Date Ran, a of Information Requested: From � to <br />EHO'D USE ONLU"f <br />E3 CONSUME <br />L %-° a <br />®PWS <br />WATER QUALrrr <br />!SR► t'\4'J F� .Cir• � vrrcMmeAnoN i <br />L1 HOLJ5 NG <br />i' <br />E CUPA <br />wkcl -I --ulI W - <br />dGupw-•-1��'� - <br />M1(`iollc WASTE <br />0 ACCOUIONO <br />i 15HVIRONIVIENTAi <br />HEALTH DEFARTMI NT <br />FILE ADDRESS <br />FILES <br />UNDERGROUND TANK (UST) <br />pwtP®®t r�r <br />straBt Name <br />cies/ <br />yk <br />CLEANUP SITE (LOP) <br />HAZARDOUS WASTE <br />r TIFRCD PERMITTED FAvLIN <br />2 <br />-f <br />SnC s5 l <br />r7 U <br />int ' I I n <br />L <br />A9ovMROUN O TANK <br />pLll UST (MONITORING/ PEMON IL) <br />HAZARDOUS MATERIALS <br />3 <br />`}(.�I•.� i <br />L. <br />(�(tjj `i ©G%t� <br />�`�Gw.'•-IMv <br />SPILL/RZLEAEE RESPONSC� <br />I <br />SOUD WASTE FACILITY I VF1 <br />4 <br />I <br />(�� <br />"' <br />U FOOD FACILITY ! X <br />(\ <br />POOLISPA <br />DAIRY <br />I a9 o <br />LAND USE APPLICATION SITZ 3 <br />I <br />I <br />I <br />I <br />W SCLC PUMPER TRUCK/ <br />• YARD / CHEMICAL TOILETS <br />WASTEWATER TREATMENT I .ANT <br />HOUSING AOATEMENT <br />T <br />[ ] MOTEUHOTEL <br />CHICKEN RANCH / DOC: KED IEL <br />I❑ <br />� <br />MEDICAL WASTE FACILITY <br />TATTOO/SODT PIERCING <br />WASTE TIRE <br />9 <br />COMPLAINT <br />— <br />a OTHER(PLEASE SPECIFY): <br />iQ <br />ACII Y9f0 < <br />I - <br />0 t'? i`1 CC O Ua. <br />I <br />E73 Records ?ora-ri iE <br />ENDae-oa <br />Inn/1 nn•� r.1O1N <br />MVRSOf]�U Ai{t=A-�T-7�1 UJG Vf`1a.�i_ <br />0M <br />t <br />10'71 0107/CI <br />