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� 4, EHD LOG NUMBER <br /> D. ` l ' " V i!J SAN JOAQUIN4 COUNTY. � <br /> 4"- ORONMEC�T L HEALTH DEPARTMENT <br /> I � �, <br /> UL 1868 East Hazelton Avenue, Stockton, CA 95205 6232 <br /> r � �E Telephone: (209)468-3420 Fax: (209)464-0138 Web:vrww.sjgov.org/ehd <br /> SG�sOVSCi k PUBLIC RECORDS RELEASE APPL=TiON <br /> `Pi_iCAf T: V1 ` BUS[NtESS/AGENCY: G' . . <br /> DDi�l;ss: - Cott lei_ ciTYrSTaTErZIP: 0 <br /> PHONE 1 : lug kit PHONE _ FAX OR E-MAIL: �`U.�Cht�rG <br /> Please allow 10 business days from date of application subs-nittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDI E�EQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT I � DATE <br /> 1. List up to ten addresses in the space Blow. Select the fype(s) of files from the list below by checking the 'appropriate <br /> box(es). At least one file type NriUST be selected. Fax to(209}464-0136 or mail to the address indicated above: Address <br /> ranges will not be accepted.Applications received after 3:00 pin will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of END 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 rive business days for review. appointments <br /> should be scheduled accordingly. <br /> 4.. A ny 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$130 deposit prior to review. <br /> WELL AND SEPTIC PERWT RECORDS ARE AVAILABLE FOR REVIEW: IVIONDAY•FRIDAY 8:00 AM-5:00K4(EXCLUDING HOLIDAYS) <br /> Eiect€onie Information: ❑ List❑ Map—Desci'ipfican: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONad h er,, ,ICO ,vr <br /> HEALTH DEPARTMENT FELE ADDRESS D U S E 0 N L Y _�� <br /> FILES <br /> DERGROUND TANK(UST) Street# Street Name city <br /> V �^ <br /> CLEANUP SITE(LOP) s Lts> t ❑CDNRUMER <br /> "OTHER CLEANUP SITE(NON-LOP) ac, pfio <br /> L,_�(HAZARDQUS WASTE ❑DAIRY <br /> TIERED PERMITTED FACILI 2 l��}g`� �t 1� JL!'N a- m ' <br /> ABOVEGROUND TANK !J A)w � /� / <br /> �I <br /> PWS <br /> [ UST (MONITORING I REM©V ) ` '_t.�------- N �6 ❑ r� f) <br /> s1;S'� t ii <br /> VHAZARROUS MATERIALS 3 Lit O"1 <br /> i <br /> PILLIRELEASE RESPONSEi <br /> [3.-UiVA2ER QUALITY t <br /> SOLID WASTE FACILITY 1 VEHICLE 4 1_lt <br /> FOOD FACILITY <br /> POOL I SPA KI-917E MITIGATION <br /> ❑DAIRY <br /> LAND USE APPLICATION SITES ` <br /> ❑Hou,ING <br /> D SEPTIC PUMPER TRUCK/ 8 <br /> YARD I CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLAIT {]CUPA <br /> HOUSING ABATEMENT 7 <br /> MOTELIHOTEL - �� <br /> tj CUPA-HAZ-MAT <br /> CHICKEN RANCH I DOG KENNEL <br /> MEDICAL WASTE FACILITY r <br /> TATTOOIBOUY PIERCING q]/SGLID WASTE <br /> WASTE TIRE 9 <br /> 0 COMPLAIIJT <br /> ACLOVNTING <br /> - <br /> OTHER(PLEASE SPECIFY): ❑ <br /> 90 <br /> —BOXED AREA-EHD USE ONLY / p <br /> 1 I �fl <br /> Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 48.06 <br />