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DATErgrk6u IV ML) EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 10 2017 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> I:MRONUBTALHE&TWelephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 0 5IL49 <br /> PERMITISENCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 13'USINESSIAGENCY: <br /> ADDRESS: �-413- ESIT0, U)()C)c Cotlrt CITY/STATE/ZIP: _t {f OWW CA g W O <br /> PHONE (1): q) qCb+.— 4f 5ci- PHONE (2): q qc - 5 FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be av it le. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$1FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 9 <br /> SIGNATURE OF APPLICANT + b0;140,2 r. 2f2f DATE M[rC,,11 IQ,:I� <br /> 1. List up to ten addresses in the space below. Select the types) of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to f209)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 END 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 $139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> Specific Date Range of Information Requested: From I qb Q to 140_' <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILESEHD-USE ONLY <br /> L UNDERGROUND TANK(UST) Street# Street Name City Q t� �aIj <br /> CLEANUP SITE(LOP) i�ir"-_l�q f IInI,�-�� �\'l I}f� kI� n y� f/j-V 11 CONSIRJIER <br /> OTHER CLEANUP SaE INON-L P 1 UT C!'4.Wtt Ra U 10C�' o I 5 �rJLQ_ <br /> HAZARDOUS WASTE ,7 [']DAIRY <br /> DU TIERED PERMITTED FADILI 2 r�•I}� � <br /> F�ABOVEGROUND TANK - <br /> ®UST (MONITORING I REMOVAL) J [�PWS <br /> 3 <br /> ®HAZARDOUS MATERIALS <br /> N SPILURELEASE RESPONSE j} WAreR QUALITY <br /> in <br /> l�FOOD FACILITY <br /> IN SOLID WASTE FACILITY 1 VEHICLE 4 ^' <br /> ''��,,]J-- <br /> POOL I SPA ,+ SITE MITIGATION <br /> ®DAIRY <br /> LAND USE APPLICATION SITES I <br /> 1 ��+ HOUSING <br /> ®SEPTIC PUMPER TRUCK I 6 <br /> YARD I CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT 1 ` r �'} CJUPA <br /> HOUSING ABATEMENT 7 ,%�-�4� <br /> MOTELIHOTEL ILIA) 1/ <br /> CHICKEN RANCH I DOG KENNEL CUPA-UST <br /> 8 <br /> Cj MEDICAL WASTE FACILITY SIT <br /> TATTOO/BODY PIERCING SCLIO WASTE <br /> WASTE TIRE S <br /> COMPLAINT <br /> ® Y� n ACCOUNTING DTHER(PLEASE SPECIi=Y): ��ttW i�� Cj�,tj,F, LUn� �(�XCS ©1� <br /> TU 00[jn0fion op proper -? <br /> Prd{'t:Tiy, Jnr exDrn IZ c(p_3 the ""BDXED_AREA-EHD USE ONLY"*' <br /> r <br /> E3 Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 4&-06 <br />