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DATE <br />W146 2016 SAN JOAQUIN COUNTY EHD LOG NUMBER <br />ENr`IROi MEWAL FEAL ENVIRONMENTAL HEALTH DEPARTMENT <br />PERP flTISEWOE, 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />ADDRESS: �« f: C (')yi4�lZE9D CITY�sTATErziP: S%(�c{.!nQ,�'t jU, GA r;;g 14 <br />Please allovr 10 Business days from date of application submittal far the records to be avai{able. <br />Staff will contact you to arrange an appointment date and time to review the requested records. <br />❑ CHECK BOX TO EXPEDITE REQUEST - $130 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINES DAYS <br />SIGNATURE OF APPLICANT SPS A"�aj6o( DATE ��0�� k,-_1 <br />1. List up to ten addresses in the space below. Select the type(s) of files 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 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 cond-'tion 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 $130 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AIA-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: E <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />FfLE ADDRESS <br />EHDUSEONLY <br />QUNDERGROUND TANK (UST) <br />Street# <br />Street fume <br />City <br />iolL"�M" <br />. <br />{/ <br />lCONSUMER <br />TJFnn "*„M v <br />.CLEANUP SITE (LOP) <br />U2OTHECLEANUP SIE(NON-LOP) <br />HAZARDOUS WASTE <br />12`TIERED PERMITTED FACILITYEEf <br />cv V <br />p <br />DAIRY <br />/'' <br />�LAk <br />ABOVEGROUND TANK <br />`� <br />`/"I V f l / <br />Y•y�/� / 1, <br />' <br />13 PWS <br />R/LIST (MONITORING/REMOVAL) <br />HAZARDOUS MATERIALS <br />U <br />03 A <br />t � <br />% <br />�n R.I�'{ vq / t <br />V 1 ! l.. <br />Lob <br />�SPILLJRELEASE RESPONSE <br />SOLID WASTE FACILITY VEHICLE <br />1 <br />j, i( <br />Y1 { <br />�"' <br />WATER QUALITY <br />❑ FOOD FACILITY <br />1Z��✓ <br />' "- "�� <br />�'� <br />1�1� I'1iii� 1 ��, / <br />USrrE MITIGATION <br />POOL I SPA <br />DAIRY <br />I v <br />1 <br />LAND USE APPLICATION SITES <br />SEPTIC PUMPER TRUCK / <br />YARD/ CHEMICAL TOILETS <br />L! <br />�� <br />,/�- I/ F 1 <br />�^` ' �`` `�/ <br />(`� (�-) <br />•`1 '; I/ n <br />❑ HOUSING <br />�� � C-* c.0 <br />WASTEWATER TREATMENT PLANT <br />CUPA <br />❑ HOUSING ABATEMENT <br />110 l <br />wood �w <br />❑ MorEUHoTEL' <br />CHICKEN RANCH / DOG KENNEL <br />❑ MEDICAL WASTE FACILITY <br />U. T 1� <br />"i/ 111 <br />�•O <br />UPA - HAZ-MAT <br />1 11U»1ll _ V _�l <br />1v( iA (�� (P( <br />❑ TATTOO/BODY PIERCING <br />TE <br />SOLID WASTE <br />FdWASTE TIRE <br />COMPLAINT <br />Ir��T <br />lv <br />V �' ` -' " "' <br />!�[ <br />�✓r1M U <br />,� 7�• <br />©/OTHER(PLEASE SPECIFY): <br />w% it <br />IoS��Vr <br />ACCOUNTING <br />�� <br />