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SANdUAWN K':Ut' V5- Plronmenia0 Heah'.h Depanment <br /> _-COU NTY--- Eld 0 6 1 i 7 PUBLIC RECORDS RELEASE APPLICATION <br /> r e a t r)e 5 5 q"C"z-v s hers <br /> EW RONMENTAL HEALTH 410 EHID LOG NUMBER: 'al 131 <br /> PEINMIMMERMER <br /> APPLICANT: BUSINESSIAGENCY: W4AA' Aj) 0)JO&Z, <br /> ADDRESS: <br /> CITY/STATE/ZIP: <br /> PHONE (1): r_T 6 PHONE (2): 2C* G64-'7'?1q5 FAX OR E-MAIL: 014t 400AW410Me-Q_ <br /> Please allow 10 business days from date of application submittal for the records to be available, 66oLnlu" <br /> Staff will cont anfp�'�me�ntdate�and time to review the requested rejcorP. <br /> SIGNATURE OF APPLICANT.- DATE <br /> 1. List up to ten addresses in The <br /> �s ac�-e below. Address ranges WILL NOT be accepted. Select the -e(s) of files from the <br /> list below by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138,mail to the <br /> address indicated below, or email to info@_smcehd.com., Applications received after 3:00 pm will be processed the next <br /> business day. <br /> 2. For assistance in identifying the nature and content of EHD records, please contact EHD at the number noted below. <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 $152 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: M List [-] Map- Description: <br /> Specific Date Range of Information Requested: From to X7{2 � <br /> ENVIRONMENTAL FILE ADDRESS <br /> HEALTH DEPARTMENT <br /> FILES (Specific addresses only,address ranges will not be acci--pted) EHD USE ONLY <br /> -ffunderground Tank(UST) Street# Street Name City <br /> Cleanup Site(LOP) ;A#^111 'LA VT <br /> 1 6X ()j� <br /> Other Cleanup Site(Non- �"" <br /> Hazardous Waste <br /> ❑Tiered Permitted Facility 2 DAIRY <br /> Aboveground Talk <br /> VNrT (Monitoring/Removal) <br /> He <br /> I Hazardous Materials <br /> vsplll/Release Response — <br /> JJJ <br /> El <br /> WATER QUALITY <br /> Waste Facility!Vehicle 4 W <br /> [] Food Facility ' <br /> 7]Fool/Spa 9srrE mmc,A­rInN <br /> E Dairy 5 <br /> F� Land Use Application Sites — [j HOUSING <br /> Septic Pumper Truck 1 6 <br /> Yard I Chemical Toilets <br /> Wastewater Treatment Plant K(CUPA <br /> F] Housing Abatement 7 AST/HM I HW <br /> 0 Motel/Hotel <br /> F1 Chicken Ranch I Dog Kennel W11-1PA <br /> 1`7 Medical Waste Facility 8 UST <br /> L Tattoo/Body Piercing E]SOLID WASTE <br /> Complaint le Tire 9 <br /> ` <br /> Other(Please SpenifY): E]AcVOUNTING <br /> to <br /> ***BOXED AREA-EHD USE ONLY*** <br /> Qectwck uom im-Z-1q-17 <br /> El Records provided by Staff-PPR Complete. Staff Name: EHD 413-06 <br /> 1'ok <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 j 209 464-0138 1 wvvw.sjcehd.com <br />