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DATE RECEIVED SAN JOAQUIN COUNTY EHD LOC NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> .SAN 12 2017 1868 East Hazelton Avenue, Stockton, CA 95205-6232 0i5ij <br /> Iq <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> AEWRONMefr&MVn PUBLIC RECORDS RELEASE APPLICATION <br /> PPLICANT: _,T0Cd6Un v BUSINESSIAGENCY: I-EE COns"u than hf <br /> ADDRESS: �,?J�© , GL,IrYj f n o d fa+1) CITYfSTATEIZIP: WaIW 4. C4 "7151' 7 <br /> PHONE (1): 1 �f�5}-7�1(o`(�rZ�J PHONE (2): FAX OR E-MAIL: (q2 U�R <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 FILE ADDRESS EHD USE ONLY <br /> FILES <br /> DgUNCERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LQP) 1.1') I 1 � <br /> T '� E]CONSUMER <br /> OTHER CLEANUP SITE(NON-LOP) YvesMay* <br /> yLYA � D&y <br /> HAZARDOUS WASTE r L]DAIRY <br /> �1� 3 f�uu>,I 1,QI S pr �D ��` <br /> TIERED PERMITTED FACILITY 2 <br /> ABOVEGROUND TANK -- - <br /> UST (MONITORING I REMOVAL) h {Al `{ I yyy[,,,yn`` (5�� j^'`�l} ' ❑PWS <br /> HAZARDOUS MATERIALS <br /> SPILLIRELEASE RESPONSE a <br /> WATER DUALITY <br /> SOLID WASTE FACILITY I VEHICLE 4 <br /> ❑FOOD FACILITY _ <br /> - SITE MITIGATION <br /> POOL 1 SPA <br /> DAIRY 5 <br /> MLAND USE APPLICATION SITES - <br /> HOUSING <br /> SEPTIC PUMPER TRUCK I B <br /> YARD I CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT f CUPA <br /> V, <br /> HOUSING ABATEMENT 7 <br /> F-1 MOTEL/HOTEL CUPA-UST <br /> I1 CHICKEN RANCH I DOG KENNEL <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> TATTOO/BODY PIERCING SOLID WASTE <br /> WASTE TIRE 9 <br /> COMPLAINT - <br /> OTHER(PLEASE SPECIFY): ❑ACCOUN71NG <br /> 10 <br /> i -"BOXED AREA-EHD USE ONLY" <br /> 0 Records provided by Staff-PPR Complete. staff Name: <br /> EHD 4e-os 1 Ll <br />