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I <br />ECIVED PEP <br />101111110 SAN JOAQUIN COUNTY EHD LOG NUMBER <br />OCT j3 2016 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />aVtTelephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />�OeY�ITAt PUBLIC RECORDS RELEASE <br />APPLICATION <br />APPLICANT: rL " <br />ADDRESS: BUSINESS/AGENCY: <br />PHONE (1): CCITY/STATE/ZIP: rr 3 , <br />PHONE (2): FAX OR E-MAIL: <br />PI ase allow 10 business days from date of application submittal for the records to be av lable. r <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE EQUEST 139 F ( ASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />1. List up to ten addresses in the s below, ect therom DATE&kh� r %� g(i, <br />box(es). At (east one file type MUST be selected. Fax to 209) 464he list below by CneCl(ing <br />-0138 or entail to the address indicatedthe aboyero riot 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 $139 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM•5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: List ❑ Map — Description: <br />Specific Date Range of Information Requested: From <br />to <br />HEALTH DEPARTMENT <br />y FILES <br />17(I UNDERGROUND TANK (UST) <br />T CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />0HAZARDOUS WASTE <br />TIERED PERMITTED FACILITY <br />ABOVEGROUND TANK <br />J <br />UST (MONITORING/ REMOVAL) <br />HAZARDOUS MATERIALS <br />SPILURELEASE RESPONSE <br />SOLID WASTE FACILITY / VEHICLE <br />❑ FOOD FACILITY <br />POOL I SPA <br />DAIRY <br />❑ LAND USE APPLICATION SITES <br />SEPTIC PUMPER TRUCK / <br />YARD / CHEMICAL TOILETS <br />WASTEWATER TREATMENT PLANT <br />HOUSING ABATEMENT <br />MOTEUHOTEL <br />CHICKEN RANCH / DOG KENNEL <br />MEDICAL WASTE FACILITY <br />TATTOO/BODY PIERCING <br />WASTE TIRE <br />aaa��--�yy <br />IyQ COMPLAINT <br />❑TOTHER(PLEASE SPECIFY): <br />FILE ADDRESS <br />Street # Street Name City <br />1-7100 1 S hideW Pkw <br />EHD USE ONLY <br />[/C CONSUMER <br />[] DAIRY <br />117�D �h►d �i�t' �kW Lisa N� o PWS �T <br />/ WATER QunLm 1`�I �/` <br />$ 111E MITIG-ON <br />B ❑ HOUSING <br />7 <br />8 1 1 1 1 9 CUPA . UST <br />B `SOLID WASTE <br />i8 I5 ACCOUNTING <br />—Rr1YPn A... cur, n..-....... <br />