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�p 27 16 04:38p Phase1Assessments 916-988-6639 p.1 <br />`�.RECEIVED <br />DATE FS EA 2016EHD LOG NUMBER <br />SAN .IOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />ENVIRONMEN IAL HEALTH 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />PERM USSERVICES Telephone: (209) 468-3420 Fax: (209) 464-0138 Weis: www.sjgov.org/ehd Bqb 7 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />ADDRESS: <br />PHONE (1): <br />L <br />BUSINESS/AGENCY: <br />CITYISTATElZIP: <br />Q Zj Z PHONE (2): FAX OR E-NWL;'r,4/2SMbV,44—' J! I <br />ease 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 EXPEDrrE REQUEST - 39 FEE (CASH OR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT 1 DATE 9 — L %— 2,c) i <br />1. List up to ten addresses in th pace below. Select a of files from the list below by checking efh appropriate <br />box(es). At least one file type MUST be selected. Fax to 12091 -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 staffat 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: El List ❑ Map — Description: <br />Seecific Date Rance of Information Requested: From to <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILE ADDRESS <br />EHD USE ONLY <br />FILES <br />cY <br />17.E UNDERGROUND TANK (UST) <br />S C2 $ <br />Street Name <br />Street <br />City <br />77� <br />lzzi) <br />/J/y���j <br />xgl; f Ll 0 <br />j/ity/may <br />C0�6UMMMEER <br />060 /C (�� /0 <br />Y CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON -LOP) <br />Y •�I �l. <br />2 <br />, <br />`d %///✓✓✓�[��CA- <br />/ /.--I/ n.w <br />cif <br />® HAZARDOUS WASTE <br />TIERED PERMITTED FACILITY <br />ABOVEGROUND TANK <br />El PNlS <br />UST (MONITORING/ REMOVAL) <br />® HAZARDOUS MATERIALS <br />SPP_URELEASE RESPONSE <br />PrWATERQUALTY <br />SOLID WASTE FACILDY / VEHICLE <br />4 <br />FOOD FACILITY <br />5 <br />$TIE MITIOAPON <br />` j/'� ' 1 <br />POOL / SPA <br />DAIRY <br />LAND USE APPLICATION SITES <br />HOUSING <br />E] SEPTIC PUMPER TRUCK I <br />6 <br />YARD I CHEMICAL TOI:ETS <br />WASTEWATER TREATUENT PLANT <br />COPA <br />HOUSING ABATEMENT <br />7 <br />MOTrJHGrEL <br />CU PA -UST <br />CHICKEN RANCH / DOG KENNEL <br />MEDICAL WASTE FACILITY <br />B <br />Ij TATTOD/BODY PIERCING <br />0 SOLID WASTE <br />WASTE TIRE <br />9 <br />COMPLAINT <br />AVI DTHER(PLEASE S�ECIFY� <br />AQOUN7I NG <br />10 <br />--BOXED AREA - EH❑ USE ON <br />A <br />Received Tiine Sep.27. 2016 4:36PM No -0065 <br />