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DATFP&XFw1VhU EHD LOG NUMBER <br /> SAN .1OAQUlN COUNTY <br /> MAR 10 20V ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> EKVF40NWBTALHF.ILTffelephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd 05IL49 <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ' BUSINESSIAGENCY: <br /> ADDRESS: D-414 Wjr W0 COUrt CITYISTATE/ZIP: Sfo�m n , C q grja10 <br /> PHONE (1): PHONE (2): "� FAX OR E-MAIL: CIi X00 <br /> Please allow 90 business days from date o application submittal for the records to be av ilk le. <br /> Staff will contact you to arrange an appointment date and time to review the requested records, <br /> [] CHECK BOX TO EXPEDITE REQUEST-$1 9 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /L�y�ttr�ctrpL DATE <br /> 1. List 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 /> 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 EMD 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 AIN-5:OOPM (EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> Specific Date Range of Information Requested: From Q to �d1} <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILESEHD_ ONLY <br /> C UNDERGROUND TANK(UST) Street# Street Name Cityt `` <br /> CLEANUP SITE(LOP) fY�� ❑CONSUMER <br /> I��� C ero ee Rd Aockhn 5 <br /> OTHER CLEANUP SITE(NON-L P <br /> N HAZARDOUS WASTE Y5� <br /> DAIRY <br /> ldTIERED PERMITTED FACILI 2 ❑ LO <br /> F]ABOVEGROUND TANK <br /> ®UST (MONITORING/REMOVAL) ❑PWS <br /> HAZARDOUS MATERIALS 3 <br /> ®SPILLIRELEASE RESPONSE <br /> WATER QUALITY <br /> SOLID WASTE FACILITY 1 VEHICLE 4 <br /> ®FOOD FACILITY <br /> Ij POOL I SPA ! SITE MITIGATION <br /> DAIRY 5 3/()- <br /> /�q + 7 <br /> LAND USE APPLICATION SITES // <br /> SEPTIG PUMPER TRUCK I 6 � Ej HousING�, <br /> YARD I CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT d"'� .--y GUPA <br /> HOUSING ABATEMENT 7 <br /> Q MOTELIHOTEL <br /> CHICKEN RANCH I DOG KENNEL ` CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> TAT-roo/BDDY PIERCING SULiO WASTE <br /> WASTE TIRE g <br /> COMPLAINT <br /> ®OTHER(PLEASE SPECIFY): 17 nU' rF Uie, 0,0, }axts 0 F. LiACCouwiNO <br /> TCV ll1¢om4tiofl 611 1° � P10It1 ? <br /> PIOQCity [nr eXarn le clue Z "-BOXED AREA-HHD USE ONLY•," <br /> Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48-°6 <br />