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0 <br />EU <br />, �y P /y, 1 Ff�'�/ 11:57:31 a.m. 04-28-2016 1 /1J <br />Is U- ED SAN JOAQUIN COUNTY r v flulvl=k <br />RV EEE��� ENVIRONMENTAL HEALTH DEPARTMENT 1, <br />1�� i B68 East Hazelton Avenue, Stockton, CA 95205-6232 `EF <br />b 5. <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd gg� <br />I a, PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY: <br />ADDRESS: rq (,tl �G Seer ie CITYISTATElZiP: <br />PHONE (1): PHONE (2)• �! /—�1O3/ FAX OR E-MAIL: <br />Please alloy 10 business days from date of application submlttal for the records to be available. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE RE 3,S � 0 -FEE (CAS CHECK ONLY) - REQUEST PROCESSED IN 3 BU( p4yS <br />SIGNATURE OF APPLICANT / DATE f / / <br />1. List up to ten addresses In the space below. Select the type(s) of Iles 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 fifes exist. An appolntment 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 revibws'by the same applicant may require a $130 deposit prier to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 5:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />EHE ADDRESS <br />FILES <br />EHD USE ONIS LY <br />UNDERGROUND TANK (UST) <br />.Street # <br />Street Name <br />City <br />CLEANUP SITE (LOP) <br />_ '•-_ OTHER CLEANUP SITE (NON -LOP) <br />• <br />/ <br />/ ( <br />A nn���777 <br />. Tracy V-41 <br />coNsunER <br />c HAZARDOUS WASTE <br />® TIERED PERM=FACIDTY <br />® ABOVEGROUND TANK <br />21 <br />^� <br />S- <br />DAIRY <br />® UST (MONITORING / REMOVAL) <br />E] PWS <br />HAZARDOUS MATERIALS <br />© <br />(f ' <br />J f <br />T?-L6"! L <br />SPIWRELEASE RESPONSE <br />4 <br />u WATER QUAUTY <br />® SCUD WASTE FACWTY I VEHICLE <br />FOOD FACILITY <br />❑ POOL /SPA <br />m�SITE MrnGAT10N <br />❑ DAIRY <br />5 <br />Z] LAND USE APPLICATION SITES <br />B <br />❑ HOLIsING <br />Lj SEPTIC PUMPER TRUCK 1 <br />YARD I CHEMICAL TOILETS <br />® WASTEWATER TREATMENT PLANT <br />7 <br />EiUPA <br />I] HOUSING ABATEMENT <br />❑ MOTELIHOTEL <br />CHICKEN RANCH / DOG KENNEL <br />® MEDICAL WASTE FACIUTY <br />0 <br />gCUPA- HAZ-MAT <br />�/{� 1 n /I /I <br />_� <br />TATTOO/BODYLOA, PIERCING <br />Q 1(\ � <br />g <br />v�SouD WASTE <br />® WASTE TIRE <br />COMPLAINT <br />OTHER(PLEASE SPECIFY); <br />10 <br />AccourmNG <br />.«BOXED AREA - EHD USE ONLY'— <br />❑ Records provided by Staff -PPR Comalefe. Staff Name: <br />Received Time—Apr, 28.-2016-11:29ANi—No, 0743 <br />