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Z_y 16 1609:22a Farshad Vakifi, P,E. (916)988-6639 p.1 <br /> OU DAT EC � ;I <br /> OU SAN-JOAQUIN COUNTY EHD LQ G NUMBER <br /> 10i AY 16 2M ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1568 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www,sjgov.orglehd <br /> EWRONmENTAL MEALTHPUBLIC RECORDS RELEASE APPLICATION <br /> n <br /> ADDREAI T; e- €` I e�1ILi 8USINESSIAGENCY: f = S� <br /> ADDRESS: X7'.3 CSN n ELLS CITYISTATEIZIP:J�aLg:6m <br /> PHOfstE(7): ' l© ^CP <br /> PHONE(2): FAX OR E-f�iAlL: f� i�f? dU �jf <br /> Please alioya 10 business days from date of appiicatian subMittal for the records to be availabie. •C��t <br /> Staff wifi contact yGu to arrange an appointment date and time to review tate requested records. <br /> ❑ CHECK BOX TO EXFEDITE REQUEST-$130 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE-OF APPLICANT DATE <br /> 4_ List up to tarn addresses in the space below. Sefecf the types)of files from the list below by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to 203 464-0138 or mail fo 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 mature and content of EHD mcords, 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 approximatelyten(10) <br /> days after receipt of application. The files vA[f 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 wilt 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 /> WELLAND SEPTIC PERMIT RECORDS ARE AVA,LASLE FOR REVIEW: MONDAY-FRIDAY 8'00 AES-S:QOPM(EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List❑ flap—Description: <br /> Specific Date Range of information Requested; From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS P ulna �q <br /> FfLES D USE ONLY <br /> UNCERGRIJUtAn TANK JUST) Street 4 Street fume City <br /> CLEANUP SITE 4LEIP) kyr (' AVE �f','r'( -ff Conswa€R <br /> IJU OTHER GLEANVPSRE IKON-L / � [/ �VGi LJ +�f/ _ }. J <br /> WHAZAPzotis WAsm 777 i! - r <br /> ! G]DfuTtY <br /> 0 <br /> TIS-0 PEwcsr-€D FAcaLmr Z Ir <br /> ABOVEGRWND TANK <br /> Q UST (MUNITORINGI REMOVAL) �FIA'S <br /> HALAPMOUS MATEPJALS 3 <br /> FT SPILL/RELEAsE RESPONSE - <br /> i1 SOLID WASTE FACILITY I VEHICLE e �vunma 4�ulrr <br /> ❑Fom FACILrTy <br /> ©POOL I SPA. - Gf SITE M1TiaAn N � <br /> DAIRY <br /> LANA LISEAPP'LICJATION SITES _ <br /> Q SEPTIC PUNPERTm)CK1 6 []HOUSI`u <br /> YAC I CHEMICAL TOILETS <br /> WA57EVJATER TP.EATM�NT PL.Arrf T [�GU PA <br /> []HOUSINGABATEMEPlr T <br /> O MOTEUHOTEL <br /> CHICrZN RANCH I DOG KENNEL [:I CLrPA-HAZ-r.IAT <br /> B <br /> fJiEDZCAL WASTE FACILITY <br /> TA-r7oosCDY PIERCING - <br /> WASTE TIRE S0U0WASTEy <br /> r�COMPLAJNT- <br /> C]OTHERIPLEASE sPECFV). _ <br /> ID C Acrntlw'rING <br /> --BOXED AREA-ENC]USE DNLy—, <br /> - //G' <br /> a r <br /> II <br /> r0_Recordsjpi)ravided by Staff-PPR Complete. staff Mame: <br /> LRD"-oB <br /> —Received Time_May,_l.b, 201E 9:22AM Ilio, 0803 <br />