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ello �� P. 1 <br />11m A RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br />C, 3- e <br />C ENVIRONMENTAL HEALTH DEPARTMENT <br />R 1868 East Hazelton Avenue Stockton CA 95205-6232 <br />EWIIIIRGFttLtEtdTAL'HEAET" Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: v✓'VW.sjgov.org/ehd <br />•PEr' r,ES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: BUSINESSIAGENCY: GGA. <br />ADDRESS: 2 g(eZ limrl1Aar+e 1S6d 5� JAI CITY/STATEIZIP: TOttwi- iI3. _`fc0505 <br />PHONE (1): PHONE (2): 1 ID- 3&,,- $5 ( - FAX OR E-MAIL: dioncS GCOAISer.�eL . <br />Please allow 10 business days from date of application submittal forthe 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- 9139 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN_a BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATEdi— I—Loi(, <br />1. Lest up to ten addresses in 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 (208) 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 />Z. 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 riles exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The files will be held fora maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />4. Any file not returned in the sane condition as released will be reorganized by EHD staff at the expense of the applicant, <br />Future rile reviews by the same applicant may require a 5139 deposit prior to review. <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM•5:00PM (EXCLUDING HOLIDAYS) <br />Electronic information: LJ List ❑ Map — Description: <br />Specific Date Range of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />EPA <br />FILE ADDRESS <br />EHD ONLY <br />_ <br />Rn1N1,e14r«OUNn TANK (UST) <br />Street# <br />Street Name <br />City <br />CLEANUP SITE (LOP) <br />OTHER CLEANUP SIT. (NOIN-LOP) <br />W -01 W H YS- �. o cD«5✓MLI. <br />/Lt -! <br />�1'IA:ARDOMu' \VA:iTt <br />71 TIFRPD PFRMITTFn FACILITY <br />Ej AucveOKOVNU TANK <br />$ <br />�a7K^ <br />CL.. <br />6sec23crfi i.-,135' a.i�f <br />' <br />2 <br />❑n•�R.T <br />NVt�e�U'" <br />0" <br />\ <br />(MONITORINS / REMOVAL) <br />�u/UST <br />AI.IIA.INDOU'u MAIGNIALS <br />WWII/RFI FASF RFRPONFF <br />SOLID WA5TE FACILITY I VF81CI.F <br />❑ FWD rALILITY <br />IO <br />A <br />H WATER OUAVIY <br />MITICATION <br />❑ POO, , 15- <br />DNRY <br />E <br />LAND USE APPLICAT,ON SITES <br />6 <br />❑ WJUSINO <br />SEFTO PUMPEK TkomI <br />YAkD / CnCMICa. 7CILFTfi <br />(] WARTFIVATF.R TRFATrAENT VVWT <br />M'ruPA <br />I4OUwNO ARATRMFNT <br />T <br />MOTF.IAIOTEL <br />IJ- CHIrKFN RANCH I OCCKPNNFL <br />Ly CVPn-UST <br />0 MEDICAL WAGTL` FA LITY <br />B <br />I] TATTOOIDODY PIERCINC <br />F1 WA ie TtKR. <br />COMFIAWT <br />B <br />Z1SOLID WASTE <br />❑ OTNER(PLEASU S'LCII'Y): <br />❑ nccouNrmD <br />O <br />110 Records provided by Staff -PPR Complete. swrrianle: 11 <br />Received Time Sep, 1. 2016 2:26PM No. 1164 <br />