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II � EHD LOG NUMBER <br /> SAN.JOAQUIN COUNTY AlY <br /> ij � 40 <br /> ENVIRONMENTAL HEALTH DEPARTMENT vff2o <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www,sjgov.org/ehd <br /> ;VIRf3 <br /> RMITI IVT4L r l ALTH PUBLIC RECORDS RELEASE APPLICATIONF11 F C, y <br /> APPLICANT: IiQ,g0 VqS Utz BUSINESS/AGENCY:A44 EAVi[d111ftG,7-M1 4/'4yp,t1G <br /> ADDRESS: 1121 G—t11/.�—q( Shy SVi to 103 CITY/STATEIZIP: (o/'orlg CA q2 irO <br /> PHONE(1): J 5 - 1 39- TI34 PHONE(2): FAX OR E-MAIL: 6VqSj V1 Z WlyriltnltnV.Cort, <br /> Please 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 EXPEDITE REQUEST-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ..I" 4 V44P j, DATE OSA26/201"1 <br /> 1. List up to ten addresses to 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 f209)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 condition as released will be reorganized by EHD staff at the expense of the applicant. / p <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 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map-Description: <br /> Specific Date Range of Information Requested: From All to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> E41ONDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) <br /> 1;16 ( ) 3c{ pUGk Cr2tk or�Ve S+oCk-ion EI CONSUMER <br /> UY vLEAN CLEANUP SITE NON-LOP <br /> E?HAZARDOUS WASTE <br /> &�TtRED PERMITTED FACILITY Z [1 DAIRY <br /> ABOVEGROUND TANK <br /> Eg,eST (MONITORING I REMOVAL) ❑PWS <br /> [31'IAZARDOUS MATERIALS 3 <br /> [S�SPILURELEASE RESPONSE <br /> SOLID WASTE FACILITY/VEHICLE 4 WATER QUALITY <br /> f-I FOOD FACILITY <br /> POOL/SPA <br /> SITE MITIGATION <br /> DAIRY 6 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ ❑HOu51NG <br /> 6 <br /> YARD I CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT <br /> HOUSING ABATEMENT 7 <br /> CUPA <br /> F1 MOTEL/HOTEL <br /> Ej CHICKEN RANCH I DOG KENNEL <br /> CUPA-UST <br /> Ei*EDICAL WASTE FACILITY S <br /> M TATTOD/BODY PIERCING <br /> F1 WASTE TIRE OLID WASTE <br /> P<OMPLAINT 9 <br /> OTHER(PLEASE SPECIFY): ' <br /> 10 ❑ACCOUNTING <br /> —BOXED AREA-EHD USE ONLY"• <br /> 5-'X-1-7-amcLtknv <br /> ❑ Records provided by Staff-PPR Complete. Staff Name: <br /> END 48-D6 <br />