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DATE RECElGElSs <br />EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />Ef�t�FiRGNMENTAL HEALTH DEEARTMiENT <br />�) <br />sG)i'a i (f 0 <br />1868 East Hazelton Avenue, Stockton, CP 05205-5232 C <br />ZN <br />Telephone: (203) 468-3420 Fax: (203) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE kPPLICATiOfq <br />kPFLtCIP tr'1�: t t 1 lrV , �r� MISii�ES51AGEF&CY: -,.L1 ��r <br />ADDRESS: f f - 1 <br />() HONE (2):_ FAX OR E-11a1AIL: <br />Please allow 10 business days from date of application submittal for the records to be avaliable. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXP fTE REQ�T - $ 30 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT ''��.YkC1-}ft��r� �I��!' _ _ DATE <br />1. List up to ten addresses In the space flow. Select the type(s) of files from the list below by checking the appropriate <br />box(es). At lerst one file type MUST be selected. Fax to (204) 464-0130 or mail to the address indicated above. AddrEss <br />range's Will not be accepted. Applications received after 3:60 pm will be processed the next business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EKD at the number noted above. <br />3. The EHD will notify the applicant if any EHD t-fias exist. An appointmant for review Will be confirmed approximately ten (1 d) <br />days after receipt of application. The flies 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 Ee reorganized by EHD staff at the expense of the applicant. <br />Fututre 'ole reviews by the carne Rpplicant may require a $130 deposit prier Cc m iev.. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:00PM (EXCLUDING KOLiDAYS) <br />Electronic information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVI_0 MENTAL <br />HEALTH DEPARTMENT <br />FILES <br />FILE ADDRESS <br />EHD USE ONLY f <br />UNDERGROUND TANK (UST) <br />Street# <br />Street Name <br />Cit <br />CziANUP SrrE (LOP) <br />CLEANUP SME <br />041I <br />I ��DUKzuuLa •-R I <br />I,Pf�JjPtHER (NON -LOP) <br />'fI <br />HAZARDOUS WASTE f' <br />YY <br />—^ <br />Uig <br />p! TERM PERMnTED FACrUTY <br />TANK <br />f <br />}�0( <br />n4.i'I <br />i L.%I x <br />I Vki. 1141 V �� Ftl <br />I F-1-5 Vt, <br />AIRY <br />J GIIr.. <br />@ECEC <br />IIS <br />r <br />,� <br />6 fAlMoVEORoUNO <br />iAfNj UST (MONITORING I REMOVAL) <br />FG HAZARDOUS f,tATERIALS <br />�!1 <br />!L" f�� <br />, ! <br />f f✓i t% B I �'� �` <br />--` <br />SPILURELEASE RESPONSE <br />SOLID WASTE FACILITY I VEHICLE <br />-f FOOD FACILITY <br />,�/ <br />I'`• <br />//JJ ��tt �� <br />C_.✓"r.V`'" <br />�.. <br />-41 <br />rI POOL i SPA <br />- <br />.S <br />[��$IT` FY{'ITF�ATION lit <br />DAIRY <br />LAND USE APPLICATION SITES <br />' <br />,.�17 <br />, ('%`• k <br />SEPTIC PUMPER TRUCK/ — <br />YARD I CHEMICAL TO¢ ETS <br />HOUSINf7 I <br />WASTEWATER TREATMENT PLANT <br />CU PA <br />❑ HOUSING ABATEMENT <br />CST <br />fri01EUHOTEL <br />❑ CHICKEN RANCH I DOG KENNEL <br />tT <br />Y [') CUPA • HAZbSHT� <br />MEDICAL WASTE FACILITY <br />W <br />lel `'�./ <br />-/�",f,/l/') <br />❑ TATTOOJBODY PIERCING <br />�_„ �._•_ So.m V9aseE <br />0 WASTE <br />COMPLAINTS <br />.9 <br />�}p/�/ <br />�I/ V <br />,{ <br />� L i 4i 0 <br />f <br />j1��I J(9_ <br />1 r <br />�OTHER(PLEASE SPECI FY): <br />I <br />�' <br />421 Ji <br />p n QACCCU' me <br />"'@DXE EA - EHD USE ONLY-' <br />71 Records provided by Staff -PPR earrtpletc. star; � <br />tHD 4Z-05 <br />� � J <br />