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ECE <br /> VED <br /> DAT RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY , <br /> MAY 2 6- 2016 ENV'IRONWENTAL HEALTH DEPA � f <br /> 1668 East Hazelton Avenue, Stockton, CA 952 -6 <br /> RfsE.Bfl <br /> ;E�£T.A_t HEALTH Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> pEW&jTiSEFZv10E, ,7 PUBLIC RECORDS RELEASE APPLICATION <br /> : <br /> APPLICANT }—+ T) BUSINESSIAGENCY: Z-AN G A-m 17R F (WJE 1-t- Ka L—,o <br /> ADDRESS: I\j 0_090 eja _L -.4,1,e ,_`l )rri 1._l() CITY/STATE/ZIP: ( �- <br /> PHONE(1): PHONE(2): 6,S pi _ � 3 A--OOI�FAX OR E-EMAIL: --i. <o <br /> Please allow 10 business days from date of application submittal for the records to be available. C1 <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> CHECK BOX TO EXPEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Mn n l"'-__ OV DATE Q_�:�2-6 12_0 /-6 <br /> 1. List uD 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$130 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 DEPARTFAENT FILE ADDRESS EHD USE ONLY <br /> FILES i <br /> (_UNDERGROUND TANK(UST) Street# Street Flame city <br /> T' f CONSUMER <br /> CLEANUP SITE(LOP) � <br /> x1 OTRER CLEANUP SITE(NON-LO )��� ' �3�3 I �-�i�`s� ��D S'7VCX-TVN -IWNjC�I�11 o/(/�/) <br /> ff 0 <br /> �HAZ.4RDOUS.JASTE El DNRY , <br /> TIERED PERMITTED FACILITY f <br /> �l � P41 <br /> ' STn C��ABOVEGROUND TANK <br /> TSIrWS <br /> UST (MONITORING/REMOVAL) LJ_ <br /> HAZARDOUS MATERIALS ©�-�I D #W ARM/ <br /> I�SPILL/RELEASE RESPONSE 6L�Vr7 <br /> Y' [g WATER(U <br /> ALITY <br /> SOLID WASTE FACILITY/VEHICLE pf1j'9U1T/_V CiO IC / /(10 <br /> ❑FOOD FACILITY <br /> ❑POOL/SPA ///���,, �./ ( Q /� Jyn �-� y, ,,/ UK <br /> �/��IQ'SIT/E`MIITIIGGGATTIONI�DAIRY TS f 1 f 1 P Sf'C f, 'D S Ll.T_-T i V ic <br /> tTl /Il II ' / /y/ <br /> ❑LAND USE APPLICATION SITES /� 1 V L Y 1. 'HOUSING v I " <br /> ❑SEPTIC PUMPER TRUCK/ y f rp [� �/} C I" kwm <br /> ('❑^`/.�'n/YARD/CHEMICAL TOILETS '" `I Of ` 4'!' "���(V <br /> ❑WASTEWATER TREATMENT PLANT /(f� <br /> ®CUTA <br /> HOUSING ABATEMENT ? 9� //' / ©Q�AI� � /f,>1 ��r. ,� , �n..❑MOTEL/HOTEL I�,10� (7"I (� N l n� (�j�_ I 11 ((( 1. \\I'll��'/' <br /> F-1CHICKEN RANCH/DOG KENNEL (,,.{J�� n UPA-HAZ•MAT <br /> CHICKEN <br /> WASTE FACILITY ��( ,J r 1 W t VY I �i � <br /> ❑TATTOOIBODY PIERCING SOLID WASTE <br /> WASTE TIRE B <br /> ❑COMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): Y Q ACCOUNTING <br /> 10 u <br /> ***BOXED AREA-EHD USE ONLY`** _^ <br /> 0 records provided by Staff-PPR Complete. staff Name: <br /> EHD 48.06 <br /> ZZ <br />