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• <br />APPLICANT: <br />ADDRESS: <br />PHONE (1):1 <br />• <br />SANJOAQUIN 1;14'7j Environmental Health Department <br />COUNTY +_.� PUBLIC RECORDS RELEASE APPLICATION <br />Please allow 10 business days from date of application submittal for the records to be available. <br />Staff will contact you to arran a an appointment date and time to review the requestedecords. <br />SIGNATURE OF APPLICANT a DATE 57/ ?I1 S <br />1. List up to ten addresses in t e space belo ddress ranges WILL NOT be accepted. Select the type(s)' <br />of fifes from the <br />list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138, mail to the <br />address indicated below, or email to info &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 END 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 file 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 — <br />Specific Date Range of Information Requested <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />1 �us`T <br />FILES <br />(Specific <br />addresses only, address ranges will <br />not be accepted) <br />EHD USE ONLY <br />AD <br />TUnderground Tank (UST) <br />Street # <br />Street Name <br />I City <br />Cleanup Site (LOP) <br />er Cleanup Site (Non -LOP) <br />l <br />�3 <br />J + " . t •li, ` <br />W�S� �-i{ <br />i;� <br />�y'f� t•4W . 14� 445 , CONSUMER <br />ttw It.vt , io/s{� <br />gazardous Waste <br />ed Permitted Facility <br />s <br />C 0- <br />j / j /'r <br />+� N <br />0 <br />NDAM <br />G 15 P <br />oveground Tank <br />; <br />A <br />3 <br />a3� <br />( k�,�' + <br />WA's ji(Q <br />�4dG /� <br />144n , ,.W r�/moi PWS <br />JST (Monitoring I Removal) <br />ardous Materials <br />pill I Release Response <br />❑ Solid Waste Facility I Vehicle <br />i <br />4 <br />�0 <br />j <br />ddb WATER QUALITY <br />❑ Food Facility <br />NO Co 160 <br />t4 nn SITE MITIGATION <br />❑ Pool/ Spa <br />Dairy✓1 <br />❑ <br />f�0 CO 5 <br />❑ Land Use Application Sites <br />Septic Pumper Truck 1 <br />e <br />/ <br />�' <br />r4 W , 4 A LJ HousING <br />co ISO <br />Ei Yard 1 Chemical Toilets <br />r J''' <br />`"G' <br />'lo <br />/0j(� <br />a;_ ; <br />114,N, <br />f I <br />ti M M 13, All CUPA <br />�� � �r LQ�S�ST I HM 1 HW <br />r <br />❑ Wastewater Treatment Plant_ <br />❑ Housing Abatement <br />❑ Motel/Hotel <br />CUPA <br />❑ Chicken Ranch 1 Dog Kennel <br />8 <br />UST <br />❑ Medical Waste Facility <br />❑ Tattoo/Body Piercing <br />❑ SouoWASTE <br />❑ Waste Tire <br />s <br />F-1 Complaint <br />i <br />❑ ACCOUNTING ; <br />Other (Please Specify): <br />—BOXED AREA - EHD USE ONLY - <br />w Ict-t t n ttvj I Pa(u- O S 36 71 S' - )r <br />1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 46 -3,VO I F 209 464-0138 1 www.sjcehd.com <br />16 <br />rVa <br />