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m m Jan. 24, 2017 9:58AM No, 3386 P, 1 <br />D IVfet DEHD LOG NUMBER <br />�� SAN JpAQUIN COUNTY <br />y ENVIRONMENTAL HEALTH DEPARTMENT <br />AN 2 4 2017 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />9541'5 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />1=Hi/IRCNTif r -m ^r-^HEAPUBLIC RECORDS RELEASE APPLICATION <br />DGDIlRlT/t�n1nr,.rn _ <br />v <br />APPLICANT: Ashley McGinnis BUSINESSIAGENCY: SJC Public Works <br />ADDRESS: 1810 E. Hazelton Ave CITY/STATE/ZIP: Stockton, CA, 95205 <br />PHONE (1): 209-468-3085 PHONE (2): FAXOR E-MAII-: 209-468-2999 <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 />Q CHECK BOX TO EXPEDI RE UE _ $13 _ _ E=E _ H OR CHECK ONLY) - REQUEST PRQCESSED IN 3_B -. INES._ DAYS <br />SIGNATURE OF APPLICANT 4,1W DATE /23 I <br />1. List up, to ten addresses iWt a space below. Select the type(s) of files from the list below by checkin thea propriate <br />box(es). At least one file type MUST be selected. Fax to (2091464-0138 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. <br />Future file reviews by the same applicant may require a $139 deposit prior to review, <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />Electronic Information: ❑ List ❑ Map — Description: <br />Specific Date Range of Information Requested-, From to <br />"r.rj <br />Re <br />ENVIRONMENTAL <br />'WEALTH .TMEN7 <br />FILE ADDRESS <br />EHD USE ONLY <br />FILE$ <br />_ffFILES <br />UNDEAGAOUND TANK (UST) <br />Street # <br />Street Name <br />City <br />CLEANUP SITE (LOP) <br />6J OTHER CLPANUP SITE (NON -LOP) <br />T <br />(Q I <br />I A ,fin y7� /. <br />S V ✓r I r ' <br />�`%1 �Vf [ I L (..!/Li <br />CONSUMER <br />ffHAZARDOUS WASTE <br />dTIERED <br />t9m-. DAIKr <br />PERMITTED FACILITY <br />2 <br />J <br />dABOVEGROUND TANK <br />-3 <br />I I/ rn y 1 <br />PWS <br />EfUST (MONITORING / REMOVAL)n <br />IJ H/SAADous MATERIALS <br />EZSPILL/RELEASE RESPONSE <br />4 <br />WATER QUALITY <br />USOLID WASTE FACILITY / VEHICLE <br />prFOOD FACILrrr9 <br />POOL / SPA <br />SITC MIiGATION <br />DAIRY <br />5 <br />BLAND USE APPLICATION SRS <br />IA HOUSING <br />Q SEPTIC PUMPER TRUCK! <br />YARD / CHEMICAL TOILFTa <br />6 <br />ErWAaTEWATER TREATMENT PLANT <br />q/HOUSING ABAYEMENT <br />/ CUPA <br />MOTEUHOTEL <br />7 <br />71 <br />Y CHICKEN RANCH / DOa I<1NNEL <br />y /I CUPA • UST <br />MEDICAL WASTE FACVrY <br />a <br />0/ <br />TATTOO/BODY PIERCING <br />SCUD WASTE <br />PASTE TIRE <br />a <br />COMPLAINT <br />OTHER(PLEASE SPECIFY)_ <br />ACCOUNTING <br />14 <br />—BOXED AREA - EMD USE ONLY— <br />4 -cords provided by Staff -PPR _ Complete. Staff Name: <br />ei ed Time—Jan. 24:-2017- 9:47AM—No 0731 <br />