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Ip 27 16 04:38p Phase1Assessments 916-988-6639 p.1 <br /> RECEIVED <br /> DATE FWMA 2016EHD LOG NUMBER <br /> SAN.IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMEN SAL HEALTH 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> PERM USSERVICES Telephone: (209)468-3420 Fax:(209)464-0138 Web;www.sjgov.org/ehd Bqb 7 <br /> PUBLICRECORDS RELEASE APPLICATION <br /> APPLICANT: ,4 ,0`9I <br /> "� L-I L BUSINESS/AGENCY: 2 <br /> ADDRESS: -- /4L_LA42 r- i CITYISTATE/ZIP: J <br /> PHONE(1): P <br /> HONE Z PHONE(2): FAX OR E-MAIL-,4f2-S <br /> P 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 EXPEDrrE REQUEST- 39 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9 —Z. 7- <br /> 1. List up to ten addresses in th pace below. Select a of files from the list below by checking efh appropriate <br /> box(es). At least one file type MUST be selected. Fax to 12091 -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 condition as released will be reorganized by EHD staff atthe 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 6:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: [I List❑Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EHD USE ONLY <br /> FILES <br /> UNOERGRCUND TANK(UST) stpet# Street Name city <br /> CLEANUP SITE(EAP) 7 tp �J t ��f� '�t�` ��/'/1�) r.�^'�CONSUM EER <br /> OTHER CLEANUP SITE(NON-LOP) �`� V'��9 �� `^ !""/ 1 110'/0wo /C( 1 '/co <br /> ®HAZARDOUS WASTE jjj111 ,n� ��/�//�� <br /> 51TIERED PERMITTED FACIiItt 2 ( <br /> ABOVEGROUND TANK •7 f�1(y(�,J��C.-� YYY /T 1 1 YY j/� ��1"`��� -- orf t <br /> PN7S <br /> UST(MONITORING/REMOVAL) <br /> ®HAZARDOUS MATERIALS 7 <br /> SPIWRELEASE RESPONSE WATER QUAL TY <br /> SOLID WASTE FACILITY I VEHICLE 4 <br /> FOOD FACILITY <br /> SnE MITIGAPON <br /> POOL/SPA I^' f <br /> DAIRY 10 .IpI 1!�— W <br /> A. <br /> LAND USE APPLICATION SITES <br /> HOUSING <br /> E]SEPTIC PUMPER TRUCK/ <br /> 6 <br /> YARD I CHEMICAL Tot,Ers <br /> WASTEWATER TREATUENT PLANT COPA <br /> HOUSING ABATEMENT 7 <br /> MOTELIHGrEL <br /> CI1PA-UST <br /> CHICKEN RANCIi/DOG KENNEL <br /> Q MEDICAL WASTE FACILITY B <br /> TATTOO/BODY PIERCING 0 SOLID WASTE <br /> WASTE TIRE <br /> 9 <br /> El COMPLAINT <br /> AVI DTHER(PLEASE S�ECDFY)- C1 A20UNA NO <br /> 1O <br /> ^'BOXED AREA-EHD USE ONLY"' <br /> n')(NL 7 — n <br /> ❑Records provided by Staff-PPR Complete. staff Nerve: <br /> EHD 4&,W <br /> Received Tiine Sep. 27, 2016 4: 36PM No. 0065 <br />