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DATE -IVLu SAN JOAQUIN COUNTY EHD LOG NUMBER <br />NOV 0 4 2016 ENVIRONMENTAL HEALTH DEPARTMENT -7 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ENVIRONMENTAL HEALTH Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd 91 <br />PERMIT/CFRtnrr:r PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Jim VUII BUSINESS/AGENCY: eA)neem Pil'VIv <br />ADDRESS: y53q N Rj��ITE "e. E 1o$ CITY/STATE/ZIP:�n <br />S., Cft �%j-7%2 <br />PHONE (1): ��r7q�?i7(p Oil IWF-' l PHONE (2):(S5Q) 2%(D'Q3H� A OR E-MAIL: )jm\f(@ fQGh111(mw <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 - $139 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 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 Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />EHD USE ONLY <br />FILES <br />® UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />oo <br />O�10 w �kAb <br />LA <br />E]CONSUMER <br />CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE NON -LOP <br />HAZARDOUS WASTE <br />_ <br />Ej DAIRY <br />TIERED PERMITTED FACILITY <br />❑ ABOVEGROUND TANK <br />❑ PWS <br />%UST (MONITORING/ REMOVAL) <br />❑ HAZARDOUS MATERIALS <br />3 <br />RSPILL/RELEASE RESPONSE <br />4 <br />WATER QUALITY <br />SOLID WASTE FACILITY /VEHICLE <br />7 FOOD FACILITY <br />5 <br />SITE MITIGATION <br />N �/ <br />I I — I <br />lV'■ <br />F] POOL/SPA <br />DAIRY <br />LAND USE APPLICATION SITES <br />W r I <br />6 <br />E]HOUSING <br />SEPTIC PUMPER TRUCK / <br />YARD / CHEMICAL TOILETS <br />WASTEWATER TREATMENT PLANT <br />CUPA <br />❑ HOUSING ABATEMENT <br />7 <br />F� MOTELJHOTEL <br />CUPA - UST <br />❑ CHICKEN RANCH / DOG KENNEL <br />MEDICAL WASTE FACILITY <br />8 <br />iI TATTOO/BODY PIERCING <br />❑ SOLID WASTE <br />WASTE TIRE <br />9 <br />COMPLAINT <br />OTHER(PLEASE SPECIFY): <br />❑ ACCOUNTING <br />10 <br />—BOXED AREA - EHD USE ONLY'"` <br />❑ Records provided by Staff -PPR Complete. staff Name: <br />EHD 48-06 / <br />11'I� <br />:fir <br />