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.-� ����"� ���H�� <br /> 8 &K 0y� 8 KUK � �������N � ����' ��� �� U�� U� o� � <br /> � 0�� U� �� 0KU8 |� ����A��K�������uo uo���o�"o ,���K]�. u����o <br /> ---COUNTY--_ <br /> MAR A72M�8 PUBLIC RECORDS RELEASE APPLICATION <br /> �^ ' <br /> G/poi"es, 9/nrs 6ereENVIRONMENTAL HEALTH <br /> PERMIT/SFR14CEL. EHD LOG NUMBER: <br /> IPAPPLICANT: BUSINESSIAGENCY: —�:T <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> 0affmII I to arranMgea,,,Optment date and time to review the requested records <br /> SIGNATURE oF4pPu <br /> ' List up to ten - -- ---ce_ --_. —`==— _ranges_ WILL_NOT-- accepted. Select the ,_`-' —files from the <br /> list below bychecking the appropriate box(ev). Atleast one file type MUST beselected. Fax to (209)464-0138,mail to the <br /> address indicated below, or email tojnfo(a-)_sJcehd.com.. Applications received after 3:ODpmwill beprocessed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <br /> x. The EMDwill notify the applicant ifany EHDfiles exist. Anappointment for review will beconfirmed approximately ten (10) <br /> days after receipt ofapplication. The files will heheld for amaximum offive business days for review. Appointments <br /> should bescheduled 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. <br /> 3/)5 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAYFR|DAYB-O8AM'6:U0PM(EXCLUDING H0LlD4YS) ~~ <br /> Flectronic. Information: A List El Map—Description: <br /> Specific Date Range ofInformation Requested: From to <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT (Specific addresses only, address ranges will not be accepted) EHD USEONLY <br /> FILES <br /> Underground Tank(JST) Street# Street Name city <br /> Cleanup Site(LOP) <br /> fo Other Cleanup Site(Non-LOP) <br /> F­j Hazardous Waste y <br /> F7 Tiered Permitted Fa6ity 2 <br /> Aboveground Tank A,1 rf)(36 -A4 (36- <br /> UST (Monitoring I Removal) WlWXYWCOAL <br /> Hazardous materials CA� S t') <br /> R Spill I Release Response <br /> Solid Waste Facility/Vehicle 4 <br /> Fcod Facillty 64� <br /> F] Dairy 6 <br /> E] Land Use Application Sites E]HousiNG <br /> I-]Septic;Pumper Truck 1 6 <br /> Wastewater Treatment Plant <br /> Housing Abatement 7 AST/HMIHVV <br /> F1 Motel/Hotel <br /> UST <br /> F7 Medical Waste Facility <br /> L Taftoc/Body Piercing E]SOLID WASTE <br /> 1-1 Waste Tire <br /> E]Compla�nt <br /> Other(Please Specify): ACCOJNT[NG <br /> *"BOXED AREA-EHID USE ONLY— <br /> El TR,,-,rds provided by Staff-PPR Complete. staff warne: - —- FHD 40-06 <br /> 1868 E. Hazelton Avenue Stockton. California A52O5 | T 209 468-3420 1 F 2884G4-0138 | www.sjcehd.com <br />