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RECEIVED <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ISEP 2 7 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH1866 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> PERMIT/SERVICES Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> J /1 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �r�� `. 1 uC�,��? BUSINESS/AGENCY: � <br /> ADDRESS: [ .�} /L . ,� ,:-�L'L,a: C - ��c i C=�_ CITY/STATE(ZIP: <br /> PHONE(9): PHONE(2): FAX OR E-MAIL: <br /> Please allow 10 business days from date of application submittal for the records to be available. <br /> t: <br /> Staff will contact you to arrange an appointment date and time to reviewthe requested records. <br /> ❑CHECK BOX TO EXPEDITER QUEST- 139 FE (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 B INESS AYS <br /> SIGNATURE OF APPLICANT DATE C1 _ <br /> 1, List uo to ten addresses in the space below. elect the type(s)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-4138 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: ist❑ Map-Description: S._L --, � , <br /> Specific Date Range of Information Requested: From (L3 f ; to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESSFILES EHD USE ONLY I1 <br /> ❑UNDERGROJND TANK(UST) Street ik Street Name City VI <br /> CLEANUP SRE(LOP) ] C. I ('. CONS:.AIER <br /> OTHER CLEANUP SITE(NON-LOP) `/v^ �(/l/LI I /�' <br /> ALARDOOS WASTE �� (' <br /> C]TIEREDPERMITTED FACILITY p r --1--1— } f ^�, <br /> E]ABOVEGROUND TANK <br /> MUST (MONITORING I REILOVAL) ❑PWS <br /> ❑HAZARDOUS MATERIALS kO <br /> 7 SPILLIRELEASE RESPONSE <br /> SOLID WASTE FACILITY I VEHICLE 4 E]WA-ER QUAD-v <br /> ❑FOOD FACILDY <br /> ❑PDOL I SPA <br /> ❑S Te Mr:GAr,DN <br /> ❑DAIRY S <br /> LAND USE APPLICATION SITES J <br /> ❑SEPTIC PUMPER TRUCK 1 ❑HOUSING <br /> 6 <br /> YARD 1 CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT <br /> ❑HOUSING ABATEMENT T CUPA <br /> MOTEUHOTEL <br /> CH!CKEN RANCH/DOG KENNEL ❑CUPA-UST <br /> MEDICAL WASTE FACILITY S <br /> TATTOOIBODY PIERCING <br /> WASTE TIRE ❑SOLID WAS <br /> ❑COMPLAINT <br /> OTHER(PLEASE SPECIF-): ❑AC:AUYfIN� <br /> 10 <br /> "'BOXED AREA•EHD USE ONLY... <br /> El Records provided by Staff-PPR Complete. Staff Name: <br /> EHD 46-06 <br />