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RECEIVED <br /> DATEF3F,CEIVF O 2016 SAN JOAQUIN COUNTY EHo LOO NUMBER <br /> • lr I ENVIRONMENTAL HEALTH DEPARTMENT ? q177 ENVIRONMENTAL HPALTH1: (2 East Hazelton Avenue,Stockton,CA b:ww .sjg <br /> PE�-`��CEs Telephone: (209)468-3420 Fax:(209)4fi40138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I:_YI BUSINESS/AGENCY: c�xe calif `. <br /> ADDRESS: CITY/STATE/ZIP: <br /> PHONE(1): PHONE(2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal 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 EXPEDITE QUE -$1 E�R CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINE DAYS <br /> SIGNATURE OF APPLICANT DATE tj <br /> 1. List un to ten addresses i th c elect a types)of flies from the list below by checkingth appropriate <br /> box(es). At least one file type MUST e s ected. 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 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 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-5:00PM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map—Description: <br /> Specific Date Range of information Requested:- From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESSFILES - EHD USE ONLY <br /> • UNOERGROUNO TAML(UST) Street# Street Name Cay <br /> OLemw SR (LOP) ❑c... <br /> IFII OTHER CLEANUP 6nE(NDN-LOP) <br /> H4 DDUs WA E ____ __ <br /> DniRv <br /> TIERED PERMR FACILm Y (J <br /> ABOVEGROUND TANK <br /> UST (MmaoNNG/RF wA) I ❑PWS <br /> RU DOUS MATERIALS NAw-u el '�+A.I�L D>f. �� i OR t, <br /> SRLURR ERE8a se I�I(/d(LrtfUl'1.1 n(/� rIC r"t'1_' 4a Wunv IV`I� <br /> SOLO WASTEFA0N 1VEHICLE /�� V�I �"1 <br /> FooDFAcam op Lim RSI Trm V M C <br /> ❑POOL!SPA E]SI MMGATON <br /> DAIRY <br /> LAND USE A UCAAON SnES <br /> SEPTIC PUMPER TRACK/ ❑HOUNNG <br /> e <br /> YAio/CHEMICAL TOIIL-TS <br /> ❑WASTEWATER TREATMENT PLANT --- CUPA <br /> ❑HousING ABATEMENT r <br /> ❑MOTEVHO <br /> ❑CHICKEN RANCH I DOG KENNF CUPA.US <br /> ❑MEOIcx vv S FAC e _ <br /> ❑TATTOOIDOV PIERCNG __.. <br /> WASTE TRE Soup WasIE <br /> 8 <br /> COMPIAINi <br /> OTHER(PLEASE SPECIFY): <br /> . �A¢auuiiNc <br /> 10 <br /> " BOXED AREA.EHD USE ONLY"' <br /> • <br /> Q Records provided by Staff-PPR Complete. staff Name: <br /> EHD 48-08 <br />