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G/ CVII VO.JVh I CJIVIIU K1 Ubb O/ /V4D v4 Jd I�C 1 <br /> 4 <br /> 9 <br /> RECEIVED <br /> iEHO LOG NUMBER <br /> \TE RECEIVED SAN JOAQUIN COUNTY <br /> FEB 2 201? ENVIRONMENTAL HEALTH DEPARTMENT ■/ / �� I <br /> Fl `Vt <br /> 1868 East Hazelton Avenue,Stockton,CA 95205-6232 <br /> IV1RQt4A <br /> ,,!;;*hone: (209)468-3420 FAX: (209)464.0138 Web:www-sjgov.org/ehd <br /> PEWIT PUBLIC RECORDS RELEASE APPLICATION <br /> i! <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: CITY/STATEJZIP:. . D g3gLZS'� <br /> PHONE(1): �(y�{��-"��L`1 PHONE(2): FAX OR E-MAIL: •' ,nr'.irr5�5PS4,�,yl <br /> 'Please allow 10 business days from date of application submittal for the records to be av at31e. <br /> Staff will contact you to arrange an appointment dais and time to review the requested records. <br /> SIGNATURE OF APPLICANT ': ' DATE '� <br /> 1. List up to ten addresses in pace b . Select the types)of Flies from the Ilst below by checking th` appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464.0'138 or mail to the address indicated Obove. Address <br /> ranges will not be accepted.Applications received after3:00 pm will be processed the next business days <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 reviewwlll be confirmed appi6ximately 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 0�1 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(EXCLUpING HOLIDAYS) <br /> Electronic Information: List❑ Map-Description: Q1 LI?460,5 <br /> Specific Date Range of Information Requested: From to - <br /> l�F� l PAlzr�tEtyT FILE ADDRESS EHD U5E ONLY <br /> P s <br /> UNDe Roum TAW(UST) Street# Street Name City n^ <br /> y-I CLEANUP SDE(LOP) /( + ;}�1" GJrveINER <br /> i U OTHER CI MUP SrM(NON-LOP' UJ `/r �(/r Y �a l L OCU <br /> �HAZARDWS WASTE ❑DAMY �I)/ <br /> TIERm PEWFACILITY 2 V <br /> 1j9b_WGRUJW TANK <br /> r4UST (MONITORING/REMOVAL) ❑ 5 <br /> G HAZARGWS MAmRWL3 0 <br /> 19 <br /> SPILURElEA.SE RESPONSE �NATEP Qty <br /> �SW ID WASTE FACIuiY/VEHICLE 4 <br /> FODO FACI'-ITY <br /> [I Pool SPA r� SIrE MInoAnaN <br /> DAIRY 5 <br /> LAND USE AP WGAnON SITES ` Housw� <br /> $EPTR:PJ MPER TRUCK/ <br /> 6 <br /> VARG/CHENR:AL TOLETS / <br /> wAtinN ER TRFATMEM PLANT 1I/IEd WPA <br /> F1 HOUSINGASATEMENT -/ I pj <br /> ❑McIsJHOTEL 0j- 1IlV/.. <br /> ❑CNICKEN PANCH/Da 1 NEL ` j COPA-UST <br /> MEDR' wA FACuw 9 \\V <br /> TATTOOIaODY PIERCWG SW G WASfE <br /> 4I WA ETIRE e j <br /> - COMPUI'N' <br /> F-1 OTMEA(P E $PECTEN)' ❑ACG(LHTING <br /> 10 I <br /> "^e0%ID AREA-EHD USE ONLY"• <br /> ❑ke6ords provided by Staff-PPR Complete. Stuff Na : <br /> Received Time Feb. 27. 2017 10: 01AM No, 0886 <br />