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r �r281708;33a Phase 1Assessments 916-988-6639 p.1 <br /> ECEIVED <br /> SAN JOAQUIN COUNTY EHD LOU NUMBER <br /> * ENVIRONMENTAL HEALTH DEPARTMENT <br /> F MEOTAL WALTH 1868 East Hazelton Avenue, Stockton CA 95205-6232 <br /> PENAIT/SE€ IMS wwvv.sjgov.org/ehd(2D9)468-3420 Fax:(209)46"138 Web:ww .sjgov.orglehdS6067 <br /> PUBLIC RECORDS RELEASE APPLICATION i <br /> APPLICANT: 1--A 4-�l L I — 1 BUSINESSIAGENCY: fr A-S15 <br /> ADDRESS': C-AW l CITYiSTATEJZIP:_ L�1KC ��_ f <br /> i <br /> PHONE(1l: — 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 REQII�T-WS13 F (CASH O K ONLY)-RE4UEST PRQCESSEa IN BUSINESS ppyS <br /> SIGNATURE OF APPLICANT DATE 21. List up to ten addressesin the spaceSelect the ty f files from the list below by checking the appropriate <br /> box(es). At feast one file type MUST be selected. Fax to 209 46 38 or rnail 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 appointmentfor review will be confirmed approximately ten(10) <br /> days after receipt of application. The fifes w-RI be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> A. 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:DDAM-5.00PM(EXCLUDING HOLIDAYS) <br /> Electronic information: E]List❑Map—Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL 1 <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> E� FILES EHD USE ONLY <br /> f� <br /> I�URDERGRooma TANK(UST) Street# m <br /> Street Nae city <br /> i <br /> CLEAN UP SITE(LOP) C3 <br /> � ©r:Ol15UL£R <br /> OYHER CLEANUP SITE(NDN-LOP) <br /> 'HAZARDOUS WASTE -� l�DF•RY <br /> F1 TIERED ROUN T'TEO FAC7LIT!' 2 ) ��i f^� \/ ,,f, .�, � i � �� <br /> AU OVa<GROUNO TANK fJ 111 Y �IQVF�..R/ <br /> ❑UST (MONITORING!RalOVAL1 [a PLUS <br /> ❑HAIARopUS MA;-GiIALS 3 i <br /> F-1 SPIUJRELEASE RESPONSE IIf <br /> SOLID WASTE FAOLTTY r VEIACLE _ ! &TER Q <br /> f7 F000 FACILTIY <br /> POOL SPA ,F <br /> [�SITE4MIT�J�OW <br /> DAIRY 5 <br /> E]LAND USE APPLICATION SITES `^ u <br /> SEPTIC PUMPER TRULK! ..— HD VSING i <br /> 5 <br /> YARD 1 CHEMICAL TOILET <br /> WASTEWATER TREATMENT PLANT" LL <br /> HOUSING ASATHIA"7 7 <br /> ©MOTELmOTEF. <br /> i <br /> CHICKEN RANCH/DAG KENNEL <br /> [I CUPA-UST <br /> ❑MEOICAL WASTE FACILELY 8 ' <br /> 0 TAT rOCIBOOY Pr-iCING <br /> WASTE TIRE ❑SCUD WASTE <br /> 9 <br /> COMPLAINT <br /> I <br /> OTHER(PLEASE SPECIFY): <br /> f0 ❑AOGOUMTnG <br /> —BOXED AREA-EHD USE ONLY"' <br /> Y <br /> 0 records provided by Staff-PPR Complete, srarr <br /> EH D 40-06 €[[ <br /> I <br /> Received Time Apr, 28. 2017 8 : 32AM No, 1342 <br />