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SAN o Q ( l;�> Y 7 ,j, Environmental Health Department <br />COUNTY#-Ec PUBIC RECORDS RELEASE APPLICATION <br />• t'F IAR - IL h EHD LOG NUMBER. <br />• <br />�j <br />APPLICANT: <br />NESS/AGENCY: <br />ADDRESS: CITY/STATE/ZIP: U 9 <br />PHONE (1): - ,� PHONE (2): s _ y? FAX Of E-MAIL: _A40 AiDole g , <br />Please allow 10 business days from date of application submittal for the records to be available. 4 <br />Staff will contact you to arran a an appointment date and time to review the requestedecords. <br />SIGNATURE OF APPLICANT a DATE sf ?I1 S <br />1. List up to ten addresses inta space belo ddress ranges WILL NOT be accepted. Select the type(s)'of files 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. 1� <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) l <br />Electronic Information: ❑ List ❑ Map - <br />Specific Date Range of Information Requested: <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />FILES <br />(Specific <br />addresses only, address ranges will <br />not be accepted) <br />j EHD USE ONLY <br />AD <br />TUnderground Tank (UST) <br />Street # <br />Street Name <br />City <br />Cleanup Site (LOP) <br />Cleanup Site (Non -LOP) <br />' <br />l <br />3 <br />' -,t �. <br />W�'S� La <br />f+91 b4W . 1 440 i CONSUMER <br />tkw li M , GD/siJ <br />ger <br />azardous Waste <br />ed Permitted Facility <br />s <br />�, C Q <br />�{/C�S� / �r � <br />y� <br />c�f <br />DAIRY <br />•(�O C`� e <br />oveground Tank <br />•,;! <br />: <br />3 <br />� <br />,' + <br />�1675u e <br />l t M �W, U)II7 PWS <br />JST (Monitoring I Removal) <br />ardous Materials <br />Pi,I Release Responsej <br />El Solid Waste Facility I Vehicle <br />4 <br />1 �0 <br />' <br />/, 1 <br />S� <br />WATER QUALITY <br />ddb <br />n Food Facility <br />tO �I <br />✓ t�' <br />No co 160 <br />�)�U�'✓� <br />N /�/� SME MITIGATION <br />F-� Pool 1 Spa <br />Dairy <br />u/(rs� 0-.2 <br />f�0 CO 5 <br />Land Use Application Sites <br />Septic Pumper Truck( <br />6 <br />jA W , 4 A LJ HousING <br />� Yard 1 Chemical Toilets <br />7 <br />jF-1Housing (� <br />a;_ <br />`� <br />/ ' <br />S t'>� � I <br />-i M l4 M OF, tf�, <br />t� GAJ, `'f w/5�ST I HM 1 HW <br />Wastewater Treatment Plant <br />Abatement <br />❑ Motel/Hotel <br />CUPA <br />C] Chicken Ranch 1 Dog Kennel <br />6 <br />UST <br />n Medical Waste Facility <br />F-1 Tattoo/Body Piercing <br />❑ SOUDWASTE <br />E] Waste Tire <br />9 <br />Complaint <br />❑ ACCOUNTING ; <br />Other (Please Specify): <br />16 <br />j <br />"*"BOXED AREA - EHD USE ONLY— <br />ovkAAK <br />-_ <br />-I <br />w Ict-1 rP+J v n ttvo h I UE Jt4r H I P a - P/ZO S 3 71 E - r./� <br />1868 E. Hazelton Avenue j Stockton, California 95205 1 T 209 46 -3,VO I F 209 464-0138 ( www.sjcehd.com <br />Priv 4 ved 00a,c,v <br />1 <br />0/ <br />