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RECEIVED <br /> DATEIR�CbEIVFA 3 20ST $ N JOAQUIN COUNTY <br /> h EHD LOG NUMBER <br /> • ENVIRON ENTAL HEALTH DEPARTMENT <br /> RONW1Y fRL F:�•'IiTH 1868 East Haz lion Avenue,Stockton, CA 95205-6232 (w/� /✓'� <br /> . PERMITI^Eni.'rMS Telephone:(209)468-34 0 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> L.� PUBLIC REC RDS RELEASE APPLICATION <br /> APPLICANT, r�r f IcT �', I BUSINESSIAGENCY: 17, �.r „ H <br /> ADORE, )�5 L S'{Lw�' SGcr�,a+OY. oA GA fl591N CITY/STATE/ZIP: .L <br /> PHONE(1): 5116 4D5 -II-)5 PHON E(2): 914-83F 36< FAX OR E-MAIL: r;µgar 'h'C-0- r/ntr cs:,toTa <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 ippointment 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'/Q•)1 <br /> 1. List un to ten addresses In space below. Sel ct the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file tyl3re 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 cont nt 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 re ulre a$139 deposit prior to review. <br /> WELL.AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic information: ❑ List❑ Map—Des ription: <br /> Specific Date Range of Information Requested: Fr)m to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY aI22 <br /> UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) / 0 CAYMSR <br /> • IZoTHER CLEANUP SITE(NON-LOP) m NS <br /> a(gHASAROOUS WASTE / ` E <br /> Vg TIERED PERMITTED FACT 1f 2 ~ � � ❑DNS <br /> I)y 1 E U-,a r W.l S�o�kkd� <br /> [3AaOWGROUNDTAN <br /> UST(MONTTORING I R VAL IZ Lt e, c e !C,0V b Pwg <br /> �HALJi[IW9 MATER <br /> ULL9 '- 1-1$`1 E GhA 'der Ww� J'fo }o.., Inou i404'y' IS/� <br /> SPILURELEASE RESPMSE <br /> SOLID WASTE FACILITY I VEHICLE 3 `�I WATDI OUADTY <br /> 1$9-1 C t t lA/m. 54 k 40 <br /> FOOD FACILITY A 4r DY^ (-`• <br /> POOL/SPA SITE MInGATION <br /> DARY g I OBJ V11A �e! WY- l Vii IDN ^ t� �J'i�d.. <br /> ❑LAND USE APKICALON SUES tl <br /> SEPTIC PUMPER TRUCK/ IJOS ( Tl r, MI .�n LK•�NCr x•_ ❑HOUSING <br /> YARD I CHEMICAL TOIETS S IDD+ C V 11 9 S1OL1, t.�� 1Q ` 1 1 „� <br /> WASTEWATER TREATMENT PLANT r 7 'I KT 'i�`1 <br /> HOUSING AaATEMENT (`rI,A'�4��I- w,1 Ntr M1 --(-Tf') I .I..I n•�yi CUPA <br /> o MDTELIHGTEL T <br /> CHICKEN RANCH I DDG KENNELt^N•ItL yL { COPA-UST <br /> MEDICAL WASTE FACILITY B )OlC ` Df1 `A 'Y' 1Q.f.vl.3 STDA• �a+.. _ V / ,',�^�/ y/ <br /> ❑TATTGOMODY PIERCING G^J J T V Y\VJJVVVWWW rrr��_��_ <br /> ❑WASTE TREt L • 1lL_ WN� �� y11. �5„fOrL SCUD WASTE ✓ <br /> M COMPLNNT J D(�k n <br /> OTHER(PLEASE SPECIFY): Q ` UVJ Li LL� A <br /> 10 rl <br /> OXED <br /> A-END <br /> ui mom' <br /> So <br /> Records provided b SStta^ff-PPR Complete.. S ff Nan(e: /� nZ4 M <br /> t![�S J <br /> EHD 48- ` OV74a ILL' •.Y A14 _ //V S ` I -'G, � <br /> oo4l� i <br /> CO it 3506 C- Co't23d6 a -• +f w = fsas dr.#� [sem�> <br />