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Ip 27 16 04:38p Phase1Assessments 916-988-6639 p.1 <br />`. <br />RECEIVED <br />DATE F SMA 2016EHD LOG NUMBER <br />SAN .IOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />ENVIRONMEN SAL HEALTH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />PERM USSERVICES Telephone: (209) 468-3420 Fax: (209) 464-0138 Web; www.sjgov.org/ehd 8qb 7 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: <br />PHONE (1): <br />L <br />BUSINESS/AGENCY: <br />CITYISTATE/ZIP: <br />Q Z PHONE (2): FAX OR E-MAILF/4f/-SMbV14k—'JV <br />ease allow 10 business days from date of application submittal 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 EXPEDrrE REQUEST- 39 FEE (CASH OR CHECK ONLY) -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT V DATE 9 — Z. 7- <br />1. List up to ten addresses in th pace below. Select a of files from the list below by checking efh appropriate <br />box(es). At least one file type MUST be selected. Fax to 12091 -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 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 staffatthe 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 6:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: i] List ❑ Map— Description: <br />IR ecific Date Rance of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />EHD USE ONLY <br />FILES <br />cY <br />17.r UNDERGRGUND TANK (UST) <br />S et $ <br />Street Name <br />City <br />77 <br />lLzi) <br />tp �J <br />'�,�� � �� `^ <br />! " " I <br />'�t1�` ��/'/�J // �^' C0 /6JU/M/SER <br />1 11�' / 0m� C i ' / c <br />Y CLEANUP SITE (LOP) <br />M OTHER CLEANUP SITE (NON -LOP) <br />V <br />/ 1 S/ <br />2 <br />/��j�,J��C..� <br />/T///✓✓✓ LLL... <br />Y -�/�` l.4{/ <br />® HAZARDOUS WASTE <br />TIERED PERMITTED FACILITY <br />51 <br />f�LABOVEGROUND TANK <br />•7 <br />/YYY <br />1 1 ` <br />j�� <br />PN7S <br />0 UST (MONITORING/ REMOVAL) <br />® HAZARDOUS MATERIALS <br />SPLURELEASE RESPONSE <br />WATER QUAL TY <br />SOLID WASTE FACILITY ( VEHICLE <br />4 <br />FOOD FACILITY <br />5 <br />$DE MITIGAPON <br />POOL / SPA <br />DAIRY <br />LAND USE APPLICATION SITES <br />HOUSING <br />E] SEPTIC PUMPER TRUCK I <br />6 <br />YARD I CHEMICAL Tot, ETS <br />WASTEWATER TREATUENT PLANT <br />COPA <br />HOUSING ABATEMENT <br />7 <br />MOTELIHGTEL <br />COPA -UST <br />CHICKEN RANCH / DOG KENNEL <br />MEDICAL WASTE FACILITY <br />B <br />TATTOO/BODY PIERCING <br />0 SOLID WASTE <br />WASTE TIRE <br />9 <br />COMPLAINT <br />DTHER(PLEASE S�ECDFY): <br />AI¢OUN7I NO <br />10 <br />—'BOXED AREA - EHD USE ONI.I" <br />Received Tiine Sep.27, 2016 4:36PM No -0065 <br />