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DATE RECEIVED <br /> ' SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ('i � 0 Jr `, � <br /> iVIRONMENTAL HEALTH DEPARTMENT ,f II <br /> C n '7 " 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ;PPLICANT: - �% ( Lsi•:. -rlP G: BUSINESS/AGENCY: " <br /> ADDRESS: ( 4 <br /> PHONE(1): <br /> CITY/STATE/ZIP: <br /> _ } � i�-. 4, �Cr 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 REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED <br /> SIGNATUREIN 3 BUSINESS DAYS <br /> OFAPPLICANT ��t� �I�� - � � ; .1 rpt- U �-r- DATE '7-ti-(�, <br /> 1. List uo to ten addresses in the space below. Select tfle types}of files from the list below by checking the appropriate <br /> box(es): At least one file type MUST be selected. Fax to(2091464-0138 or mail to a addressindicated 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$130 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 /> Pacific Date Range of Information Requested: From �20 _ i „ '} to <br /> 'i ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS EFI® USE ONLY <br /> FILES <br /> ❑UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) L�,�p <br /> ,1 � I[/, /7 Mrll /� 0 CONSUMER <br /> , OTHER CLEANUPSITE(NON-LOP) 35W JCC).5 0,`j / - / /X C , 111 L +�t H-P <br /> -kA7.ARDOUS WASTE 11 • �l V✓� ll I l" <br /> 5-TIERED PERMITTED FACILRY 2 N ''A^LL , OAIRv <br /> ZABDVEGROUND TANK ] <br /> GUST (MONITORING/REMOVAL) t ❑PWS <br /> RDous MATEwAlS <br /> B 14VJ- (Io5�10f0 — DI(Gs <br /> ❑SPILURELEASE RESPONSE - /I <br /> V, <br /> ❑SOLD WASTE FACILRY/VEHICLE , Ay _ P( �t I_ ,��_ o/q!_/lO 01 n ❑WATER OUPIIT" <br /> ❑FODD FaaLm LLII <br /> ❑POOL/SPA ❑SITE MU GATON <br /> ❑DNRY 6 <br /> LAND USE APPLICATION SITES <br /> ❑SEPTIC PUMPERTRUCK1 - ❑HOUSING <br /> 6 <br /> YARD/CHEMICAL TOILETS <br /> ❑WASTEWATER TREATMENT PLANT ®''CUPA <br /> ❑HOUSING ABATEMENT 7 <br /> ❑MOTELMOTE. - ••,, <br /> CHICKEN RANCH/DOG KENNEL COPA- <br /> B <br /> ❑MEDICAL WASTE FACILITY _ <br /> ❑TATTOO/BODY PIERCING <br /> ❑SOLID WASTE <br /> Q WASTE TIRE g <br /> F-1 cOMPLAINT <br /> ❑OTHER(PLEASE SPECIFY): ACCOUNTING <br /> 10 <br /> ­BOXED AREA-EHD USE ONLY'"" <br /> F' r,� ,1 rig � . -•, n r � ,vL , `n ..:�: 1 ;:,:a � ; �_ ;,•= h ; 1 "is-v�- � i� <br /> 4,^ , ' gn. - (1ci)v <br /> ❑ Records(provided U Staff-PPR Complete. staff NBR,B. <br /> EHD 48-06 �` 001/1�►b, �nW,-J-�D-L refoo- }- YO - gOP ��es'd' 5 ZOIb <br />