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is <br />RECEIVED <br />JUL 12 20.18 Environmental Health Department <br />---COUNTY— �.1� t,�r �� ` PUBL� RECORDS RELEASE APPLICATION <br />h::,'§NVIR0N'MENT <br />PERMITJSEME—M BY EMA <br />EHD LOG NUME3ER. lc�q <br />i <br />APPLICANT: LRUlneiJ BUSINESSIAGENCY: S�j C :N2�. jt C: UC��(�'.S <br />ADDRESS: I.P/ 0i'r�_2 ��;l n "Ave-, CITY/STATE/ZIP: ( r 6 <br />PHONE (1): r i 1- , �''� — PHONE (2): FAX ORE -MAIL: %.Sc ��s < <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact you to arpri a an appointment date and time to review the requested records. <br />SIGNATURE OF APPLICANT,, -_'1>0(7j_? DATE '-7./j-7 1.1 a <br />1. List up to ten addresses jrf the space below. Address ranges WILL NOT be accepted. Select the type(s) o files from the <br />list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138, mail to the <br />address indicated below, or email to infoOsicehd.com. Applications received after 3:00 pm will be processed the next <br />business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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 $152 deposit prior to review. 7/ " <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 Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />1111ol <br />Ig—VnItidad RPTrslug ond daliiii(s1 in ttvuw- <br />FILE ADDRESS <br />_ <br />1 S. do. CD00115 7 (0 to .5.5 burocL <br />CD ILa I <br />FILES <br />(Specific addresses <br />(p <br />only, address ranges will not <br />y 9 <br />be acre ted <br />accepted) <br />EHD USE ONLY <br />Underground Tank (UST) <br />Street # <br />Street Name <br />City <br />Cleanup Site (LOP)/ <br />}�, Other Cleanup Site (Non -LOP) <br />LSI <br />T <br />J`��� <br />Wt-j_-C]CONSUMER <br />�Fj �� <br />4 Hazardous Waste <br />1,4k <br />NO Ct.pQ C:oPQ' DAIRY <br />Tiered Permitted Facility <br />Aboveground Tank <br />2 <br />C' <br />L j– g t y 0,71'i , <br />S�Dc' <br />%V �� T <br />❑ PWS <br />1',Q (Monitoring / Removal) <br />Hazardous Materials <br />4 <br />3 <br />��d`� <br />tt� An t� <br />S. i f zyc �f.G/ C�' <br />/-{� <br />j SC t N� <br />_'M, <br />, <br />M x! <br />�yy� c*r <br />TI' i 1 ftW l 11t' I <br />qSpill / Release Response <br />j Solid Waste Facility/ Vehicle <br />4 <br />4M� z <br />lk;T <br />t4•19. �• ATER QUALITY <br />Qc Food FacilityNOc <br />C <br />tAX ICC <br />,"v+ <br />SITE monnou <br />u <br />Pool I Spa <br />Dalry <br />~- <br />t�t� <br />-S ' �' <br />N C'IWQ <br />yv <br />/ <br />Land Use Application Sites <br />§ M v <br />Ly—usinte <br />Septic Pumper Truck ! <br />Yard I Chemical Toilets <br />6 <br />Q <br />IL <br />Wastewater Treatment Plant <br />Housing Abatement <br />7 <br />}�,� r n <br />ItM�)�N <br />®CUPA <br />�v�r m1 AST/HMIHW <br />Motel/Hotel <br />v <br />O <br />UPA <br />Chicken Ranch / Dog Kennel <br />Medical Waste Facility <br />6 <br />UST <br />Tattoo/body Piercing <br />Souo WASTE <br />Waste Tire <br />g <br />Complaint <br />Other (Please Specify): <br />p ACCOUNTING <br />10 <br />'BOXED AREA - EHD USE ONLY' <br />t��1 <br />1111ol <br />Ig—VnItidad RPTrslug ond daliiii(s1 in ttvuw- <br />_ <br />1 S. do. CD00115 7 (0 to .5.5 burocL <br />❑ Records provided by Staff -PPR Complete. staff Name: -- torl>6Ced DM2 Z1CD EHD 48-00 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />�p <br />ME, <br />