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RECEIVED <br />DATE """'EHD LOG NUMBER <br />tai 1 3 201% S N JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT 5(90 RONAREFi'TAL � 1868 East Haz Iton Avenue, Stockton, CA 95205-6232 /✓� <br />• � �� EIW <br />S , Telephone: (209) 468-34 0 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />RECRRDS RELEASE APPLICATION <br />APPLICANT: sr -L (�..T :,..'. nuaMFcclerrmry TT __r C..... _. A— — <br />0 <br />ADDRESS:'cbirtat i'- CITYISTATE/ZIP: " <br />PHONE(1): o%LiD5-12.'15 PHON (2):916-$3$• 365 FAX ORE -MAIL: LµgAr 1h;�d�r4r'f..erts:.c.or+� <br />Please allow 10 business days from ate of application submittal for the records to be available. <br />Staff will contact you to arrange an �ppointment date and time to review the requested records. <br />CHECK BOX TO EXPEDITE EQU STA $139 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 2-/p•1� <br />1. List un to ten addresses In space below. Select the type(s) of files from the list below by checking the appropriate <br />box(es). At least one file tyllb MUST be selected Fax to (2091464-0138 or mail to the address indicated above Address <br />ranges will not be accepted. Applications recelvc d after 3:00 pm will be processed the next business day. <br />2. For assistance in Identifying the nature and contmit 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. <br />Future file reviews by the same applicant may rei juire a $139 deposit prior to review. <br />WELL. AND SEPTIC PERMIT RECORDS ARE AVAILAB E FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: I I List <br />to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILES <br />FILE ADDRESS <br />EHD USE ONLY <br />UNDERGROUND TANK (UST) <br />Street fF <br />Street Name <br />city <br />i <br />l�y� <br />E Dr•� r�'� <br />s�(j(i <br />❑ CONSLLNER <br />N�� <br />CLEANUP SITE (LOP) <br />OTHER CLEANUP SUE(NON4.OP) <br />(qgHP3M[IOUS WASTE <br />�J <br />u Ec <br />l`-I'd� <br />I'J` TIERED PERMITTED FACILITY <br />S <br />II -1 <br />r / 1t f V�1 1. 1�� <br />❑ DNRY <br />25ABOVEGROUNDTANK <br />, ^/f ,-r /1 [I PWS <br />MUST (MONITORING l REMOVPL) <br />[5HAzweous MATERIALS <br />�-y SPILURELEASE RESPONSE <br />I� SOLD WASTE FACILITY/VEHICLE <br />/ <br />4 <br />1- './ u•\ <br />t�"`A �L: <br />c .t <br />10T\ <br />WATER QMLNY <br />FOOD FACIUTT <br />"�1 <br />"" <br />j�D� <br />❑ POOL / SPA <br />❑DWRY <br />6SUEMMGATMN <br />❑ LAND USE APPLICATION SUES <br />B <br />�g o5 <br />�r i le .,n LyV}�Er K�^• <br />ti L..� 9 <br />(�{ <br />S� eL o- <br />❑H <br />UfC AinWBiNG <br />SEPTIC PUMPER TRVCKI <br />YMDICHEMICPLTOEETS <br />❑ WASTEWATER TREATMENT PLANT <br />C All <br />L <br />CUPA <br />❑ HOUSING ABATEMENT <br />T <br />' 0l .1 <br />[ f T.µ11 <br />Q1-�1 Oh <br />MOTEUHOTEL <br />Jt <br />8 <br />IQD f <br />W�LN1E <br />Dr MNLNM`T 1� <br />[ �D6 <br />CUPA•UST <br />❑ CHICKEN RANCH l ODD KENNEL <br />❑ MEDICAL WASTE FACILITY <br />1 U NAr <br />J DAy <br />❑ TATTONBODY PIERCING <br />❑WASTE TIRE♦ <br />J <br />B <br />loth <br />I• ' NT-/ <br />5 W <br />r11 <br />SauDWAs <br />❑ COMPLAINT <br />❑ OTHER(PLEASE SPECIFY): <br />A=UNONG <br />10 <br />