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SEHD LOG NUMBER <br /> ATE RECEIVED <br /> SAN JOAQUIN COUNTY <br /> JUL Q 7 29166 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 : ' <br /> Eli ORONTOENTALMOM6phone: (209)468-3420 Fax: (209)464-0138 Vveb:www.sigov.org/ehd 4 <br /> pERA/i1T1SEPVECE8. PUBLIC RECORDS RELEASE APPLICATION <br /> PLICANT: (�I�a�yfJ(}fYISf�(f&'� BUSINESS/AGENCI`: <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE (i'lJ'UPHONE(2): FAX OR E-Itr[AIL: <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 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 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 neted 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 /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FELE ADDRESS EHD USE ONLY <br /> FILES <br /> VLUNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) { --,1/I ❑CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) � � '"- '�tJ� <br /> HAZARDOUS WASTE /; t I v ry�`,t p DNRY <br /> rl[ftl Ir@ .+FJ <br /> TIERED PERMITTED FACILITY <br /> ii _ ___ _ <br /> '®ABOVEGROUND TANK � � �-�- k��-�_ �Q PWS <br /> (UST (MONITORING/REMOVAL) <br /> 3 <br /> HAZARDOUS MATERIALS <br /> (- SPILURELEASE RESPONSE WATER QUALITY <br /> SOLID WASTE FACILITY/VEHICLE 4 1 <br /> ❑FOOD FACILITY <br /> $ITE MRIGATON <br /> ❑POOL/SPA <br /> ❑DAIRY S <br /> i-1 LAND USE APPLICATION SITES HDL':II:G <br /> ❑SEPTIC PUMPER TRUCK I 6 <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT CUPA <br /> ❑HOUSING ABATEMENT T <br /> ❑MOTEUHOTEL ja`CUPA-HAZ-MAT <br /> E]CHICKEN RANCH/DOG KENNEL <br /> e <br /> MEDICAL WASTE FAGIDtt 1-12:-4(P <br /> F1 TATTOO/BODY PIERCING' ❑SOUD WASTE <br /> Ej WASTE TIRE S <br /> COMPLAINT <br /> OTHER(PLEASE SPECIFY): ❑ACCOUNTING <br /> iD <br /> ""BOXED AREA-EHD USE ONLY" <br /> ❑ Records provided by Staff-PPR Complete. staff Name: LZ <br /> EHD 46.06 <br />