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sit t b Z:U I b b '_� UANI <br />��.a,., 0. 1 195 P. 1 <br />E L I D RUSHr <br />0 0 DATE RECEIVED EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />MIN ®�-'�ia ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />CWR0#4W_ ffi L f-C-ALTH Telephone: (209) 468-3420 Fax: (209) 464.0138 Web: www,sjgov.org/ehd q900 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: �$nndy�Tlheeler BUSINESS/AGENCY: Ninyo & Moore <br />ADDRESS: 1401 Halyard Drive, Suite 110 CITY/STATE/ZIP: 'West Sacramento, CA 95691 <br />PHONE (1): 916-317-3284 PHONE (2):916-373-9858 FAX OR E-MAIL: rlwhccicr@ninyoandmoore.com <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 />R CHECK BOX TO EXPEDIT�QUEST - $139 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �^^—� DATE /D 26 : /�, <br />1. List up to ten addresses In tk6 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 (709) 464-0138 or mall 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 behold 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-5:00PM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map -- Description: I <br />Specific Date Range of Informallon Requested: From /,773 to pr45c.n <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />- <br />FILE ADDRESSFILE <br />EHD USE ONLY <br />nX UNDERGROUND TANK (UST) <br />Street # <br />Street Name <br />City <br />T <br />� <br />19405 <br />E. Mariposa Road <br />Stockton <br />❑ CONCLIMEA <br />CLEANUP SITE (LOP) <br />OTHER CLEANUP ARE (NON•L�P) <br />® <br />Q HAZARDOUS WASTE <br />TIERED PERMRTEO FACILMY <br />AsovEOROUND TANK <br />19899 <br />SkiffRoad <br />Stockton <br />❑ PWS <br />Q UST (MONITORING I REMOVAL) <br />dHAZARDOUSWTERWE <br />SPILL/RELEASE RESPONaE <br />SOUR WASTe FAaLnY / VEHICLEAYM <br />a <br />11685 <br />E_ Mariposa Road <br />Stockton <br />5555 <br />Jack Tonc Road <br />Stockton <br />Q,1unv <br />N <br />F] FOOD FACIUTY <br />`] POOL /SPA <br />Q DAIRY <br />y' <br />SRE MMaATION <br />LAND USE APPLICATION SITES <br />G <br />n 1 j ❑ HDUswo <br />�/ L, / / / 1 1 u - i /� I 1 t/1. <br />I] SEPTIC PUMPER TRUCK / <br />YARD / CHEMICAL TOILETS <br />D WASTEWATER TREATMENT PLANT <br />❑ HOUSING ASATCML+Nr <br />V <br />CJI <br />7 <br />CUPA <br />MOTEL/HOTEL <br />CHICKEN RANCH / Doe KENNEL <br />CUPA- UST <br />MEDICAL WASTE FACILITY <br />9 <br />TATTOO/BODY PIERCING <br />8 <br />❑ SOLID WASTE <br />q WASTE VIRE <br />GOMPLAINT <br />(1 OTHER(PLEASE SPECIFY): <br />io <br />❑ AGCOUWINU <br />'"BOXED ANEA - EHE USE ONLY•" <br />(0IIn <br />11 NW <br />