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r. IU " j ep®)� No. O 1 P. 1 <br /> f DaTB ® E c t+' E SAN JOAQUIN COUNTY O I-OG NUMBER <br /> �f NAIM" <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT (15 2016 East Hazelton Avenue,Stockton, CA 95205-8232 <br /> Telephone:: (2(209)480-3420 Fax:(209)484-0138 Web:www.sjgov.org/ehd <br /> EWgONMENTAL PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIC . _� urL4Y1_5�0_Ll BUSINESS/AGENCY• C:EA5 Env;-o1JJr owt2+I., ,T.Aje <br /> ADDRESS: Cjk q9b—( <br /> PHONE(1): �$It� zw�-90Ss �C�3L1 PHONE(2) �IU1gOg'�fo�Qi KAXOR E-MAIL: _9f P�r� 0 Qom$, ►,; <br /> Please allow 10 business days from date of application submittal for the records to be availaule. <br /> [ 6Staff will contact y u to arrange an appointment date and time to review the requested records. <br /> HECK BOX TO E)CREDIT qUE (ggSH OR CHECKONLY)-BEQUEST PROCESSED IN 3 USIA ESS DAYS <br /> SIGNATURE OF APPLICANT DATE r 0 s( 16 <br /> 1. List unto ten addresses In th ace Blow. Select the types)of files from the Ilst below by checking the approprlate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0136 or mail to the address Indicated above Address <br /> ranges will not be accepted.Appllcadons 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 00) <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-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: 0 List 0 Map—Description: <br /> Specific Date Range of Information Requested: From 'k, to All <br /> ENVIRONMENTAL <br /> HEALTH:DEPARTMENT I FILE ADDRESS <br /> FI�Es: EHD USE ONLY <br /> UNCERGROUNOTANK(UST) $treat# street Name City <br /> FANVPSITE(LOP) 1 /� JrGL.n's L-JOrL'� <br /> 9,,,-----,,,///10TNFA CLEANUP SITE(NON-LOP) L�Z$ I rt („I(„�n ❑CONBUM5i <br /> �RDOUS WAM ,�Lyyy' olq <br /> 1 <br /> TIEREDPERMITTEDFACILITY �I � �� "N ` NIVI � ID�� <br /> ,tJ—�,'Al90VE6ROUNO TANK -L* to `� <br /> [ZUST (MONITORINGI REMOVAL) E]Pws <br /> f(HHA7ANDOUS MATEN ALS <br /> jV SPILL/REI.mae RESPONSE <br /> ❑SOLID WAETE FACILITY I VEHICLE A ATER QUALITY <br /> ❑FOOD FACGIY <br /> E]j]POOL/SPA sag M_I'TIIw^'0N <br /> DANDY 6 <br /> ❑:AND USE APPLICATION SITES <br /> jj SEMC PUMPER TRUCK/ [I HOWIW <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> 2<VASTeWAYER TREAYMENT PLANT <br /> d HOUSINGADATEMENT 7 <br /> _jyCUPA <br /> Q MDTF, MOTEL <br /> ❑CHICKEN RANCH I DOG KENNEL <br /> CUPA-VST <br /> ❑MEDICAL WASTE FACILITY 0 <br /> 0 TATTMOOOY PIERCING <br /> ❑WASTE TIRE ❑SOLID WASTE <br /> ❑COMPLAINT 6 <br /> ❑OTHER(PLEASE SPECIFY): <br /> TO ❑.samulttWs <br /> _ao DAREA-EHD VSE ONLyY"' <br /> — 5 <br /> LI Records provided by Staff-PPR Complete. smrf NA e- <br /> Received Time Oct. 5. 2016 . 1 : 33PM No- 0100 <br />