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v l� d} �4 �'•.` Oyu= ...� ���U4�7L0 7 1LU7 t04Ul3 S i 2 <br />DATE RECEIVED EHD LOG NUMBER <br />:�_ SAN JOAQUIN COUNTY <br />0C' f 'J 3 2611 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />s1lifzt7bm �;=„� z+ F'E'ik' y Telephone: (209) 468-420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PEI�ARITfN6`R.\acFS PUBLIC RECORDS RELEASE APPLICATION 6 601 <br />APPLICANT: a` -t LApj 3 BUSINESSIAGENCY: P � e&A k <br />ADDRESS: 1%\ P ttJ . S"r-4-k-5(3 CITY/STATEIZIP: Qytll <br />PHONE (1): -to-t, C77.A 4117-Ti3ij PHONE (2): FAX OR E4ML: <br />Please allow 10 business days from date of application submfttal for the records to be avallable. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUES $139 OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 1011311(0 <br />1. List up to tan addresses In the space . Sahct the from the Nat below by checking the a6propriate <br />box(es). At least one file type MUST be selected. Fsx to (M) 464-0138 or maH 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 IdwAffying the nature and content of EHD records, phase contact EHD at the number noted above. <br />3. The EHD will notify the applicant H any EHD files exist An appointment for review will be conflrmed approximately ten (10) <br />days after receipt of application. The flies will be heli 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 <br />pplicantFuture 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: <br />Specht Date Range of Information Requested: From Arw- to �..�. <br />WEALTH tis TMENT <br />FILE ADDRESS <br />EHD USE ONLY <br />uMoeTLcxa,ro TANf( (Usn <br />Street I Strnet Nam. <br />City <br />D. <br />WWI ,`lir /C `.i <br />CLE~ SITE (LOP) <br />OTHER CLEANUP SITE(NON-LOP) <br />HALARDOLIS WASTE <br />TIrREomA <br />PnTEo FAcuTY <br />Abm*aROUND TAMC <br />, <br />2 <br />o � <br />Kl UST (Motmo;a w / RF► AO <br />❑ PAS <br />HAZARDOUS MATERIALS <br />3 <br />SPLLIRELEASE RESPOMSE <br />4 <br />0-1 <br />SOLD WASTE FAmrry / VEHICLE <br />O FOOL FACUTY <br />❑ Pool / SPA <br />LAND SITES <br />S n AtrwATTOw <br />❑ Houaw <br />SEPTIC PwaPem Tr )CK / <br />YARD I CmawtcAL TOLE T,5 <br />WASTFWAniR TkfATuENT PLANT <br />Ho M AbATEMEW <br />C] MOTELH.TEL <br />7 <br />COPA <br />ChdCKEN RAWCM / Doo KEM+EL <br />k4mr-AL WASTE FACLITY <br />a <br />CUPA- L IIT <br />0 TATTOW30CYY PBLC►x) <br />8ouo WASTE <br />WAM TRE <br />❑ COMPLAINT <br />rt <br />O OTHERTLEASE SPECIFY). <br />10 <br />0 A=MjwnNG <br />"'eOXED AREA -EHD (!iE Or{LY"' <br />00 <br />CuT-757-5 7 T:Tp' J <br />I ❑ Records provided by Staff -PPR Complete. sur <br />Received Time=Oct, 11. 2016= 9;20AM--No.0152 <br />