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'-_1 GV I / VO.j7t-m I CI IVII U FISSCSS 01 /VGJJ`h7J IJd I�C 1 <br /> �u <br /> RECEIVED <br /> �0 kTE RECEIVED $AN .IOAQUIN COUNTY EHD LOG NUMBER <br /> FEB 2 o 4 2017 ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Haze:ton Avenue,Stockton, CA 95205-6232 <br /> &1MRONMENTAL hone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PEWrr ' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: CAA <br /> ADDRESS; CITY/STATEIZIP:`. <br /> PHONE(1): �yf{���( -77-5st PHONE (2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be avafla5le. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> GHi l T£i i=XDITE i �l t a atrs3 <br /> SIGNATURE OF APPLICANT DATE , <br /> 1. List up to ten addresses in l .pace berSelect the type(s)of files from the list below by checking t " appropriate <br /> box(es). At least one file type MUST be selected. Fax to (209)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 npted 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 require a $139 deposit prior to review. <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:OOPM(EXCLUbING HOLIDAYS) <br /> Electronic Information: XList❑ Map-Description: <br /> Specific Date Range of Information Requested: From to <br /> Ehl! II [ylNlEht'rAI <br /> tl�,tialrlaalrlr�T FILE ADDRESS EHD USE ONLY <br /> EiLE9 <br /> 'Q UNDERGROUND TANK(LIST) Street# Street Name city <br /> CLEANUP SITE(LOP) �, - CONSUMER <br /> 07HER CLEANUP SITE(NON-LOP) �� (i Lam/ <br /> HAZARDOUS WASTE ❑DAIRY 3F•V^ <br /> TIERED PERMITTED FACILITY 2 (/ <br /> .c�ABOVEGP.OJ ND TANK <br /> Pws <br /> UST (MONITJRING/REMOVAL) 'X/ ❑ <br /> r1Ll, <br /> 9 HAZARDOUS MATERIALS 3 J ,f <br /> I � <br /> 19PILL <br /> S /RELEASE RESPONSE <br /> `r{ WATER QUALITY <br /> �SOLID WASTE FACILITY/VEHICLE 4 <br /> FooD FACI'_1TY <br /> POOL/SPA (� siTE f tl ncATION <br /> F-]DAIRY <br /> LAND USE APPLICATION SITES ' - <br /> HOUSING <br /> SEPTIC PUMPER TRUCK) / ❑ <br /> 6 <br /> YARD/CHEMICAL TOLETS <br /> WASTEWATER TREATMENT PLANT ®CUPA <br /> HOUSING ABATEMENT 7 <br /> MOTEIJHoTEL <br /> E]CHICKEN RANCH I DOG KENNEL - ` fih CUPA-UST <br /> MEDICAL WASTE FACILITY 6 <br /> TATTOOBODY PIERCING SOUL WASTE <br /> WASTE T rE I <br /> 9 <br /> COMPLA N- <br /> F_­l OTNER(PLEASE SPECIFY)' ❑A¢ou'+TING <br /> 10 <br /> """ROKED AREA-EHD USE ONLY"" a <br /> I } <br /> �i <br /> ❑ ecords provided by Staff-PPR Complete. Staff Name: <br /> 'Received Time Feb: 27, 2017 10 : 01AM No, 0886 <br />