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9� DI=CEIVED <br /> V tiC6 SAN JOAQOI r Environmental Health Department <br /> A <br /> CO U N TY - SEP `L 7 lUjr PUBLIC RECORDS RELEASE APPLICATION <br /> WITH � IyGES EHD LOG NUMBER: Y <br /> APPLICANT: E 1ZQ e BUSINESS/AGENCY:AEI Con-Qyj*o-yltS <br /> ADDRESS: 520 ?—C)C( CITY/STATE/ZIP: <br /> PHONE(1):S(O-9U"�3J X2-1( ' PHONE(2): FAX OR E-MAIL: eCru({Pr-o�pi i rutnn=IhtnhS <br /> Please allow 10 business days from date of application submittal for the records to be available. o yl <br /> Staff will come CJ u,tQ rrang�an appointment date and time to review the requested records. <br /> SIGNATURE OF APPLICANT ((/ [/,/�-� ?C"7/1 DATE_Q�'I <br /> 7. List uo to ten addresses in ace Belo . Address ranges WILL NOT be accepted. Select the type s)of 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$152 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) L/ k <br /> Electronic Information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From aa to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES (Specific addresses only,address ranges will not be accepted) EHD USE ONLY <br /> Underground Tank(UST) Street# Street Name City <br /> leanup Site(LOP) <br /> Other Cleanup Si[e(Nom LOP) <br /> 1�0 Ncrr+h ftliel Sive 111 t�cee oennaeM� <br /> Q/Hazardous Waste <br /> Iyf$:en:d Permitled Facility 2/'� Il S^] � / f 9/� (In \TY�ry /�y"� OJy'f ❑Dunv <br /> L.-,1/AJ e ,.ucd Tank <br /> IrJ'Y (M.mtam,gI Remov f0. `7 :,aLpws <br /> ardous Materials a r•- !r <br /> Spill/Release Response / <br /> ❑Solid Waste reality/Vehicle 4 ` ew-Am-Ouaun <br /> Faod Facil4y <br /> Pool/Spa tw) <br /> ooV\ �Si>E Mmr=nnon <br /> F-1 Dairy a <br /> Lj Land Use Application Sites <br /> ,I.I. <br /> Septic Pumper Truck I e 5 r file , l a W 1C Housac� � <br /> Yard IChemical Toilets <br /> ❑Wastewater Treatment Plant Irl. — n ,./� CUPA <br /> E]HousingAbatement t I �yp. r ,(�/ p 09 (J4e- <br /> rrrvvv...---ill ` CJI ASi/HMIHW <br /> ❑MotelMatel <br /> F1 Chicken Ranch/Dog Kennel TP F-1 ;ICU Metlical Wase Facilely a UST <br /> Tattoo/Body Piercing <br /> C]a S.U.Waste <br /> WTire a <br /> ompiaint <br /> Other(Please specify): 0 Accouvn. <br /> 10 <br /> "`BOXED AREA-EHD USE ONLY— <br /> ❑ Records provided by Staff-PPR Complete.staff Name: EHD4"1 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.corn <br />