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No 0264 P Mill 1/1 <br /> DATE RECI=INFO EHD LOG NUMBER <br /> ���� I SAN JOAQUIN COUNTY <br /> APR <br /> > ENVIRONMENTAL HEALTH DEPARTMENT <br /> L-tMtOI' FAL FlI:�J\.TH 9868 East Hazefton Avenue, Stockton, CA 95205-6232 <br /> PERhflT1SEWSES <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web.wvvw.sjgov.org/ehd 95091 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: _0I� BUSINESS/AGENCY: L^(4V5 %/1t„'Irvtijy�ti� 1 Tn G, <br /> ADDRESS: 3 }renes CITYISTATt=1ZIP: 4 ,¢ OIe�5'�q <br /> PHONE(1): �( )z�t �g8B5 t? f 3 t[ PHONE(2): to, qog—8'689 FAX OR E-MAIL: r eres, <br /> Please allow 10 business days from date of applicatfon submittal for the records to be avai able, <br /> Staff will contact you to arrange an appolntment date and time to review the requested records, <br /> L►/CHFCK BOXTO EXPDI R -$ PSE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Li IT/!-7 <br /> 1. List tap to ten addresses i�, na p e below. Select the type($) of files from the list below by checking the appropriate <br /> box(es). At(east one file type MUST be selected. Fax to(209)464-0138 or mall to the address indicated above Address <br /> ranges will not be accepted.Applications received after 3:00 pm will ba 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 EHO will notify the applicant If any EHD flies 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 appllcant, <br /> Future file reviews by the same applicant may require a $139 deposit prior to review- <br /> WI=LL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5;OOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ Map —Description; <br /> Specfflc Date Range of Information Requested: From 1540 to 7-01 _ <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILE$ EHD USE ONLY <br /> tTNDERe.ROJR0 YANK(usY) Steoet# Street H me City <br /> CLEANUP S1TE(LOP) 1 y j ,A 1 vena 7c / .��^ Q GONOWER <br /> OTHER CLEANUP SITE(NON-LOP) 2SOD� W 1 L+iA�1 N Yt./S�1 �-_� ����� , <br /> dALIFQous WAaTE <br /> (,cILAs Q r <br /> FRED PERM1Tf£D FACILITY R ��y� Lmin p DAJW <br /> AISOVEX ROUND TANK <br /> UST (MONITORINGIREMOVAL) <br /> F f HA2AR000S MATERIALS 3 <br /> ZSPILURELEASE RESPONSE <br /> SOLID WA@TE FACILITY/VEHICLE 4 WATER QLLeLITY <br /> F7 FOOD FACILITY <br /> n POOL I SPA <br /> J��l"� SITE MITIGATION <br /> DAIRY 6 ✓ ' "'S G � In <br /> r]LAND Uar APPLICATION STYES Hl—a SEPTIC PUMPER TRUCH) "++ 1111 <br /> ' 6 <br /> YARD I CHEMICAL TOILET8 <br /> ❑WASTEWATER TREATMENT PLANT - - <br /> NOUSINOAAATEMEN7 T CUPA <br /> MOTELIHOTEL <br /> Cj CHICKEN RANCH I DOG KENNEL CUPA-UST <br /> MEDICAL WASTE FACILITY B <br /> Q TATTOO/BODY PIERCING - <br /> LI WASTE TIRE d 8441)WASYO <br /> a <br /> F]COMPLAINT <br /> OTHER(PLEASE SPECIFY): - <br /> 70 ❑ACCOUNTING <br /> -BOXED AREA EHD WE ONLY•"• <br /> L-1-3— : G,, c�icel 1lSL �,1,�,-wc ti a4 yf� X <br /> ^.l <br /> -4102 10 1 <br /> 1"UO Tel <br /> 0 Records provided by Staff-PPR Complete. StafNAme: <br /> Received Time 4pr. 7. 2017 2 , 19Piy NO- 1210 <br />