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■ ■ <br />mily 18 18 01:53p <br />0■ <br />0 <br />• <br />• <br />M <br />!. r <br />SAN JOAQUIN �'` ?"' Env <br />-- C O D U; Y H JH <br />PMR <br />SUBMIT BY EMAIL <br />p.1 <br />ironmental Health Department <br />PUBLI� RECORDS RELEASE APPLICATION <br />,6V EHD LOG NUMBER: V C' <br />APPLICANT; L&Ar? (�, r'79 N r'�:, (� BUSINESSIAGENCY: <br />ADDRESS: /0P 4-c., c ,D,:yr' CITYISTATE/ZIP; j��csE�?•�i'�1, (� `�y1 � 3 <br />PHONE (1): `jG- PHONE (2): FAX OR E -MAIL -j(21 <br />Please allow 10 business lays from date of application submittal for the records to be brvailable <br />Staff will contact yQu to rra ad appoi tment date and time to review the requested records. <br />SIGNATURE OF APPLICANT(! DATE <br />1. List up to ten addresses in the"s ace below. Address ranges WILL NOT be accepted. Select the type(s) of files from the <br />list below by checking the aPerggPpriate box(es). At least one file type MUST be selected. Fax to (209) 454-0138, mail to the <br />address Indicated below, or entail to infoQ)sicehd.com. Applications received after 3:00 pm will be processed the next <br />business day. <br />2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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 rile not returned in the same condition 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 $152 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />FILE ADDRESS <br />�- C mlzt� l8 <br />HEALTH DEPARTMENT <br />FILES <br />(Specific addresses <br />i p <br />only,address ranges will not <br />9 <br />be acc ted) <br />accepted) <br />EHD USE ONLY <br />Q Umdergmund Tank (UST) <br />Street 4 <br />Streat Name <br />City <br />1 <br />2-700 <br />J/ <br />❑ CONSe MFT. <br />Cleanup Site (LOP) <br />O/%jher Cleanup Site (Nan -LOP) <br />1 <br />a zardaus Waste <br />D aA'a✓ <br />Q Tiered Permitted Facility <br />Tank <br />2 <br />Z_ 7o L <br />No <br />10, <br />• <br />No OF) 04 QDISQ <br />Q'Aboveground <br />(a//sT (Monitoring ! Removal) <br />❑ PINS <br />ZerdOus Materials <br />3 <br />t,C/ <br />27v r <br />• <br />• <br />1�i� <br />Spill /Release Response <br />4 <br />270 <br />WnrtF Quem <br />I <br />E]Solid Waste Facility ! Vehicle <br />[] Food Facility <br />O <br />ire MrtGA-110N <br />Pool ! Spa <br />❑ miry <br />5 <br />L7vyFillD <br />fit <br />Land Use Application Sites <br />5 <br />s <br />r; <br />E3 Flo�su� <br />[� Septic Pumper Truck / <br />Yard / Chemical Toilets <br />• <br />�1 <br />NV <br />CUPA <br />Wastewater Treatment Plant <br />Housing Abatement <br />z <br />2712 <br />Will <br />ASTIHMI HW <br />MotelMotel <br />• <br />NO O O <br />a <br />Z7W <br />CUPA <br />UST <br />Chicken Ranch 1 Cog Kennel�• <br />heedreal Waste Faclty <br />'vo <br />Taltoo/9ody Piercing <br />n <br />SOL -to WnsTE <br />Waste Tire <br />Complaint <br />g <br />b AccoL,.nNc <br />E] Other (Please Specify): <br />10 <br />"`80XED AREA-EHD USE ONLY " <br />' i 1,— �".t'. +`�' c -k, 1 7 ., t eC, <br />ll/i kt, I <br />❑ ecords provided by Staff -PPR Complete. staff Name: EH04a46 <br />1668 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />Received Time May.18, 2018 2:57PM No.3569 <br />