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DAT -IVLu SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> NOV 0 4 2016 ENVIRONMENTAL HEALTH DEPARTMENT -7 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ENVIRONMENTAL HEALTH Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd 91 <br /> PER PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 0-im VUel BUSINESS/AGENCY: e6h )i?�et�lY1 ({, <br /> ADDRESS: 4539 N grow IN AW. ST ►o$ CITY/STATE/ZIP:�SK, G/} T3_72-2- <br /> PHONE <br /> j_722PHONE (1):��r7q�?i7(p i O�I-.?SII PHONE (2):(S15Q)Z7(D'g3iI� A OR E-MAIL: )j(Y) eGh111GmW <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-$139 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1. List up to ten addresses in the space below. Select 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)464-0138 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:OOPM (EXCLUDING HOLIDAYS) <br /> Electronic Information: ❑ List ❑ Map— Description: <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT FILE ADDRESS <br /> FILES EHD USE ONLY <br /> ®UNDERGROUND TANK(UST) Street# Street Name City <br /> CLEANUP SITE(LOP) E]�oo � Lo u�� w � CONSUMER <br /> OTHER <br /> ( I�I'�IQ�p <br /> OTHER CLEANUP SITE NON-LOP) utt LLt,n_YD'e P <br /> 05 <br /> El HAZARDOUS WASTE _ DAIRY <br /> TIERED PERMITTED FACILITY 2 <br /> ABOVEGROUND TANK <br /> %UST (MONITORING/REMOVAL) ❑PWS <br /> ❑HAZARDOUS MATERIALS 3 <br /> RSPILL/RELEASE RESPONSE <br /> WATER QUALITY <br /> SOLID WASTE FACILITY/VEHICLE 4 <br /> 0 FOOD FACILITY <br /> El POOL/SPA 0 SITE MITIGATION <br /> DAIRY 5 I I —I 61 <br /> LAND USE APPLICATION SITES <br /> SEPTIC PUMPER TRUCK/ 6 [:1HOUSING <br /> YARD/CHEMICAL TOILETS <br /> WASTEWATER TREATMENT PLANT WfCUPA <br /> ❑HOUSING ABATEMENT 7 <br /> ❑MOTELJHOTEL <br /> ❑CHICKEN RANCH/DOG KENNEL CUPA-UST <br /> 8 <br /> MEDICAL WASTE FACILITY <br /> TATTOO/BODY PIERCING <br /> ❑SOLID WASTE <br /> WASTE TIRE 9 <br /> F-1 COMPLAINT <br /> F]OTHER(PLEASE SPECIFY): ❑ACCOUNTING <br /> 10 <br /> ""BOXED AREA-EHD USE ONLY'"` <br /> ❑ Records provided by Staff-PPR Complete. staff Name: /_T11 <br /> EHD 48-06 / <br />